Provider Demographics
NPI:1538153432
Name:PARIKH, KETAN P (MD)
Entity type:Individual
Prefix:
First Name:KETAN
Middle Name:P
Last Name:PARIKH
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 1:910 WASHINGTON RD
Mailing Address - Street 2:STE A
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5845
Mailing Address - Country:US
Mailing Address - Phone:443-205-1111
Mailing Address - Fax:410-927-8139
Practice Address - Street 1:910 WASHINGTON RD
Practice Address - Street 2:STE A
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157
Practice Address - Country:US
Practice Address - Phone:443-205-1111
Practice Address - Fax:410-927-8139
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2992207UN0901X
MDD0061452207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405264100Medicaid
MD405264100Medicaid
MD132021YBDBMedicare PIN
H39468Medicare UPIN