Healthcare Provider Details

I. General information

NPI: 1508814849
Provider Name (Legal Business Name): ANISH SHARAD PATEL MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 THOMAS JOHNSON DR SUITE C
FREDERICK MD
21702-4895
US

IV. Provider business mailing address

11350 MCCORMICK RD EXECUTIVE PLAZA 1, SUITE 501
HUNT VALLEY MD
21031-1002
US

V. Phone/Fax

Practice location:
  • Phone: 301-620-0012
  • Fax: 301-620-9687
Mailing address:
  • Phone: 301-620-0012
  • Fax: 301-620-9687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberD64315
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberD0064315
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: