Healthcare Provider Details

I. General information

NPI: 1255603346
Provider Name (Legal Business Name): NIRALI A DEPASQUALE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIRALI A PATEL CRNP

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 07/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 ORLEANS ST
BALTIMORE MD
21224-1020
US

IV. Provider business mailing address

3501 SINCLAIR LN
BALTIMORE MD
21213-2029
US

V. Phone/Fax

Practice location:
  • Phone: 410-558-4747
  • Fax: 410-732-0185
Mailing address:
  • Phone: 410-732-8800
  • Fax: 410-534-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0001223328
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR206077
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: