Healthcare Provider Details

I. General information

NPI: 1518574151
Provider Name (Legal Business Name): MADHAVI PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 SOLOMONS ISLAND RD
EDGEWATER MD
21037-1416
US

IV. Provider business mailing address

3025 SOLOMONS ISLAND RD
EDGEWATER MD
21037-1416
US

V. Phone/Fax

Practice location:
  • Phone: 410-798-8715
  • Fax:
Mailing address:
  • Phone: 706-255-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN265045
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR250854
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN265045
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR250854
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: