Healthcare Provider Details

I. General information

NPI: 1063830933
Provider Name (Legal Business Name): MAUNIK PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 23RD ST NW
WASHINGTON DC
20037-2342
US

IV. Provider business mailing address

2131 13TH ST NW
WASHINGTON DC
20009-7508
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-5154
  • Fax: 202-715-4901
Mailing address:
  • Phone: 859-396-6188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberD0102486
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: