Healthcare Provider Details

I. General information

NPI: 1811830318
Provider Name (Legal Business Name): RIA SAMIR PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12165 ELM ST
PRINCESS ANNE MD
21853-1358
US

IV. Provider business mailing address

3015 EDWARDS ST
ALTON IL
62002-4057
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-1015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: