Healthcare Provider Details

I. General information

NPI: 1114363025
Provider Name (Legal Business Name): SHREYAS PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2013
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 TWIN SPRINGS RD
HALETHORPE MD
21227-3553
US

IV. Provider business mailing address

1701 TWIN SPRINGS RD
HALETHORPE MD
21227-3553
US

V. Phone/Fax

Practice location:
  • Phone: 202-578-2313
  • Fax:
Mailing address:
  • Phone: 301-992-5191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMT203695
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: