Provider Demographics
NPI:1386962652
Name:VAGHELA, PRATIKSHA VISHAL PATEL (MD)
Entity type:Individual
Prefix:
First Name:PRATIKSHA
Middle Name:VISHAL PATEL
Last Name:VAGHELA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1630 CHESTON LN
Mailing Address - Street 2:APT A
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1933
Mailing Address - Country:US
Mailing Address - Phone:859-619-6648
Mailing Address - Fax:
Practice Address - Street 1:811 CROMWELL PARK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:859-619-6648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00800582083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine