1932386703 NPI number — DR. DHAVAL R PATEL

Table of content: DR. DHAVAL R PATEL (NPI 1932386703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932386703 NPI number — DR. DHAVAL R PATEL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
DHAVAL
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932386703
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 GALLOWS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALLS CHURCH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22042-3300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-776-4001
Provider Business Mailing Address Fax Number:
703-776-7113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11800 SUNRISE VALLEY DR STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RESTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20191-5303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-437-5977
Provider Business Practice Location Address Fax Number:
703-478-2475
Provider Enumeration Date:
01/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  0101251417 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1932386703 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 221543800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01094927 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 097383400 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".




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