Healthcare Provider Details

I. General information

NPI: 1619069374
Provider Name (Legal Business Name): THAKOR G. PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST NW
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

10980 RICE FIELD PL
FAIRFAX STATION VA
22039-1692
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8178
  • Fax: 202-745-8184
Mailing address:
  • Phone: 202-273-8490
  • Fax: 202-273-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101040628
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: