Healthcare Provider Details

I. General information

NPI: 1679339824
Provider Name (Legal Business Name): DHARA PATEL PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8818 CENTRE PARK DR STE 200
COLUMBIA MD
21045-2236
US

IV. Provider business mailing address

14341 HOLLYHOCK WAY
BURTONSVILLE MD
20866-1757
US

V. Phone/Fax

Practice location:
  • Phone: 240-342-2666
  • Fax:
Mailing address:
  • Phone: 410-370-3763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number07412
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: