Healthcare Provider Details

I. General information

NPI: 1073771440
Provider Name (Legal Business Name): CHIRAG PATEL MD, DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14955 SHADY GROVE RD SUITE 330
ROCKVILLE MD
20850-8700
US

IV. Provider business mailing address

14955 SHADY GROVE RD SUITE 330
ROCKVILLE MD
20850-8700
US

V. Phone/Fax

Practice location:
  • Phone: 301-340-0101
  • Fax: 301-340-1689
Mailing address:
  • Phone: 301-340-0101
  • Fax: 301-340-1689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT189448
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS035888
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number14467
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: