Healthcare Provider Details

I. General information

NPI: 1174636716
Provider Name (Legal Business Name): TUSHAR G PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 11/27/2023
Certification Date: 10/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3914 CENTREVILLE RD SUITE 250
CHANTILLY VA
20151-3289
US

IV. Provider business mailing address

3914 CENTREVILLE RD SUITE 250
CHANTILLY VA
20151-3289
US

V. Phone/Fax

Practice location:
  • Phone: 703-435-1223
  • Fax: 703-435-1868
Mailing address:
  • Phone: 703-435-1223
  • Fax: 703-435-1868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101037830
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: