Healthcare Provider Details

I. General information

NPI: 1356323570
Provider Name (Legal Business Name): VINITA PATANAPHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 01/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BRASS MILL RD SUITE E
BELCAMP MD
21017-1217
US

IV. Provider business mailing address

2234 COLONIAL BLVD
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 410-272-9224
  • Fax: 410-575-7591
Mailing address:
  • Phone: 239-931-7342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberD21798
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: