Healthcare Provider Details

I. General information

NPI: 1457323362
Provider Name (Legal Business Name): PAVNI VINODRAY PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 CROSSROADS DR STE 100
OWINGS MILLS MD
21117-5441
US

IV. Provider business mailing address

10373A REISTERSTOWN RD
OWINGS MILLS MD
21117-3617
US

V. Phone/Fax

Practice location:
  • Phone: 410-356-8186
  • Fax: 410-356-4180
Mailing address:
  • Phone: 410-356-8186
  • Fax: 410-356-4180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberD0060617
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: