Healthcare Provider Details

I. General information

NPI: 1205823010
Provider Name (Legal Business Name): SURYAKANT J PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 SURRATTS RD SUITE 303
CLINTON MD
20735-3362
US

IV. Provider business mailing address

920 ELKRIDGE LANDING RD SUITE 303
LINTHICUM MD
21090-2917
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-8485
  • Fax: 301-868-0638
Mailing address:
  • Phone: 443-642-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0019631
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: