Healthcare Provider Details

I. General information

NPI: 1497704027
Provider Name (Legal Business Name): ADDALA PATEL AND ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9135 PISCATAWAY RD SUITE 210
CLINTON MD
20735-2549
US

IV. Provider business mailing address

9135 PISCATAWAY RD SUITE 210
CLINTON MD
20735-2549
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-1380
  • Fax: 301-868-4514
Mailing address:
  • Phone: 301-868-1380
  • Fax: 301-868-4514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SRINIVAS ADDALA
Title or Position: OWNER
Credential: MD
Phone: 301-868-1380