Healthcare Provider Details

I. General information

NPI: 1033189279
Provider Name (Legal Business Name): DILIP DEVJEEBHAI PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HEALTH CLINIC 3259 CATLIN AVE
QUANTICO VA
22134
US

IV. Provider business mailing address

4721 PICKETT RD
FAIRFAX VA
22032-2027
US

V. Phone/Fax

Practice location:
  • Phone: 703-784-1626
  • Fax: 703-784-1554
Mailing address:
  • Phone: 703-978-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0039858
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: