Healthcare Provider Details

I. General information

NPI: 1871870535
Provider Name (Legal Business Name): YESHA PATEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 PARKWAY DR SUITE 500
HANOVER MD
21076-1388
US

IV. Provider business mailing address

806 PHYLLIS ST
ODENTON MD
21113-2285
US

V. Phone/Fax

Practice location:
  • Phone: 443-949-0814
  • Fax: 443-949-0825
Mailing address:
  • Phone: 717-343-0758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA055205
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0005392
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: