=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114453727
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEEPA PATEL M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2017
-----------------------------------------------------
Last Update Date | 07/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15245 SHADY GROVE RD STE 480
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20850-6243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-681-7397
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3715 CHEVY CHASE LAKE DR
-----------------------------------------------------
City | CHEVY CHASE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20815-5808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-327-4053
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | D0093320
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------