Provider Demographics
NPI:1679905905
Name:PATEL, TEJAL S (PT)
Entity type:Individual
Prefix:DR
First Name:TEJAL
Middle Name:S
Last Name:PATEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:TEJALBEN
Other - Middle Name:S
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:20410 CENTURY BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1186
Mailing Address - Country:US
Mailing Address - Phone:301-540-6140
Mailing Address - Fax:
Practice Address - Street 1:20410 CENTURY BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1186
Practice Address - Country:US
Practice Address - Phone:301-540-6140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC18256OtherBCBS
NCQ44233AMedicare PIN