Provider Demographics
NPI:1104541176
Name:PATEL, DIPA ROHIT
Entity type:Individual
Prefix:
First Name:DIPA
Middle Name:ROHIT
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5429 FOREST KELLY CT
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-1010
Mailing Address - Country:US
Mailing Address - Phone:443-687-4739
Mailing Address - Fax:
Practice Address - Street 1:5429 FOREST KELLY CT
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-1010
Practice Address - Country:US
Practice Address - Phone:443-687-4739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0008652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine