Healthcare Provider Details

I. General information

NPI: 1295737914
Provider Name (Legal Business Name): KANAIYALAL PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KANU PATEL M.D.

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7231 HANOVER PKWY SUITE B
GREENBELT MD
20770-2027
US

IV. Provider business mailing address

7235 HANOVER PKWY SUITE B
GREENBELT MD
20770-3601
US

V. Phone/Fax

Practice location:
  • Phone: 301-441-3122
  • Fax: 301-441-3124
Mailing address:
  • Phone: 301-441-3122
  • Fax: 301-441-3124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD0021799
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD21799
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License NumberD0021799
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: