Provider Demographics
NPI:1285606194
Name:PATEL, MAYUR MAHENDRABHAI (MD)
Entity type:Individual
Prefix:DR
First Name:MAYUR
Middle Name:MAHENDRABHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7253 AMBASSADOR RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2710
Mailing Address - Country:US
Mailing Address - Phone:410-356-8186
Mailing Address - Fax:410-356-4180
Practice Address - Street 1:21 CROSSROADS DR
Practice Address - Street 2:STE 100
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5441
Practice Address - Country:US
Practice Address - Phone:410-356-8186
Practice Address - Fax:410-356-4180
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043071207U00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKA80OtherB/C B/S
MD759521200Medicaid
DC2849OtherB/C B/S
MDJ062OtherB/C B/S
MD434L686SMedicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 01
MDE24140Medicare UPIN
MD12784A00Medicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 99
DC2849OtherB/C B/S
MDCN2566Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MDCD4495Medicare ID - Type UnspecifiedRAILROAD MEDICARE