Healthcare Provider Details

I. General information

NPI: 1447410246
Provider Name (Legal Business Name): VISHAL ANIL PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2008
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19455 DEERFIELD AVE STE 311
LEESBURG VA
20176-8102
US

IV. Provider business mailing address

2150 PENNSYLVANIA AVE NW STE 2B-430
WASHINGTON DC
20037-3201
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-9751
  • Fax:
Mailing address:
  • Phone: 202-677-6775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101287658
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberD0086148
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD046568
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: