Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 26NJ00765700 | NJ |
NPI | 1003326810 |
---|---|
Provider Name | Mr. Moenil Patel |
First Address | Hollywood, MD 20636-0640 |
Second Address | Waldorf, MD 20603-4527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2017 |
Last Update Date | 14/01/2022 |