Basic Information
| Provider Information | |||||||||
| NPI: | 1669482964 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | PIYUSH | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19745 EXECUTIVE PARK CIR | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208742642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019466623 | ||||||||
| FaxNumber: | 3015409448 | ||||||||
| Practice Location | |||||||||
| Address1: | 19703 EXECUTIVE PARK CIR | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208742639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019466623 | ||||||||
| FaxNumber: | 3015409448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 01/31/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D00056345 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 401493601 | 05 | MD | MEDICAID |