Provider Demographics
NPI:1265596159
Name:PATEL, AMI MAHENDRA (MD)
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:MAHENDRA
Last Name:PATEL
Suffix:
Gender:F
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:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-5720
Mailing Address - Fax:410-328-5685
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:NEPHROLOGY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-5720
Practice Address - Fax:410-328-5685
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT185905207R00000X
PAMD432996207RN0300X
MDD76533207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA313-0018OtherCAREFIRST BC/BS
MD321230100Medicaid
MD328998YA1MMedicare PIN
MDP01399256Medicare PIN