Healthcare Provider Details

I. General information

NPI: 1932412780
Provider Name (Legal Business Name): DHRUVI N PATEL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17213 COLE RD STE 17233
HAGERSTOWN MD
21740-6981
US

IV. Provider business mailing address

17213 COLE ROAD STE 17233
HAGERSTOWN MD
21740
US

V. Phone/Fax

Practice location:
  • Phone: 240-329-4699
  • Fax:
Mailing address:
  • Phone: 240-329-4699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA2194
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: