Healthcare Provider Details

I. General information

NPI: 1851393466
Provider Name (Legal Business Name): CHETANKUMAR B PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 GUILFORD DR SUITE 201
FREDERICK MD
21704-5193
US

IV. Provider business mailing address

7101 GUILFORD DR SUITE 201
FREDERICK MD
21704-5193
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-2775
  • Fax: 301-662-2776
Mailing address:
  • Phone: 301-662-2775
  • Fax: 301-662-2776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number64822
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number64822
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: