Provider Demographics
NPI:1194727719
Name:PATEL, MILAN (DO)
Entity type:Individual
Prefix:DR
First Name:MILAN
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4500 POND WAY
Mailing Address - Street 2:SUITE 170
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5581
Mailing Address - Country:US
Mailing Address - Phone:571-542-4950
Mailing Address - Fax:571-285-1160
Practice Address - Street 1:4500 POND WAY
Practice Address - Street 2:SUITE 170
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5581
Practice Address - Country:US
Practice Address - Phone:571-542-4950
Practice Address - Fax:571-285-1160
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102201726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1194727719Medicaid
VA008634D40Medicare PIN
VA1194727719Medicaid