Provider Demographics
NPI:1538747423
Name:PATEL, DIPEN (R PH)
Entity type:Individual
Prefix:
First Name:DIPEN
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 DERRICO PL
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-2839
Mailing Address - Country:US
Mailing Address - Phone:201-744-0481
Mailing Address - Fax:
Practice Address - Street 1:30 HIGH ST
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-1846
Practice Address - Country:US
Practice Address - Phone:240-448-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist