Healthcare Provider Details

I. General information

NPI: 1831488196
Provider Name (Legal Business Name): POONAM PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 E MONUMENT ST STE 6-100
BALTIMORE MD
21287-0020
US

IV. Provider business mailing address

14332 TIMBERGREEN DR 14332 TIMBERGREEN DR
HUNTERSVILLE NC
28078-0609
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-3380
  • Fax:
Mailing address:
  • Phone: 704-756-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9211
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: