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General NPI Number Information
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NPI Number | 1821112723
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Entity Type | Individual
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Provider Name | SUKETU I PATEL M.D,, D.M.D
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Gender | Male
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Dates
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Enumeration Date | 03/17/2007
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 1715 FREDERICK ST
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City | CUMBERLAND
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State | MD
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Zip | 21502-1037
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Country | US
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Telephone | 301-722-3205
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Fax | 301-722-3207
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Provider Business Mailing Address
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Address Line | 1715 FREDERICK ST
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City | CUMBERLAND
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State | MD
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Zip | 21502-1037
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Country | US
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Telephone | 301-722-3205
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Fax | 301-722-3207
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401411283
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0101238043
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 13683
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License Number State | MD
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