Provider Demographics
NPI:1366608879
Name:PATEL, SONAL GIRISH (MD)
Entity type:Individual
Prefix:DR
First Name:SONAL
Middle Name:GIRISH
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 1:4416 E WEST HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4572
Mailing Address - Country:US
Mailing Address - Phone:301-652-6800
Mailing Address - Fax:301-913-2817
Practice Address - Street 1:4416 E WEST HWY STE 201
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4572
Practice Address - Country:US
Practice Address - Phone:301-652-6800
Practice Address - Fax:301-913-2817
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118277208000000X
CAA1223902084N0402X
MDD847562084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0222075OtherBLUE CROSS GROUP NUMBER
IL3631498336019001OtherCDPG HFS PAYEE ID
IL1033149844OtherGROUP NPI
IL1366608879OtherNPI
IL036118277Medicaid
IL363149833OtherGROUP TAX IDENTIFICATION NUMBER