Basic Information
| Provider Information | |||||||||
| NPI: | 1467657866 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | NARENDRA | ||||||||
| MiddleName: | MAFABHAI | ||||||||
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| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4900 KOGER BLVD | ||||||||
| Address2: | SUITE 125 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274072736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364854900 | ||||||||
| FaxNumber: | 3364854933 | ||||||||
| Practice Location | |||||||||
| Address1: | 4900 KOGER BLVD | ||||||||
| Address2: | SUITE 125 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274072736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364854900 | ||||||||
| FaxNumber: | 3364854933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2007 | ||||||||
| LastUpdateDate: | 05/26/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 37269 | IA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 2015-00164 | NC | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 32113 | SC | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 70102 | 01 | IA | WELLMARK BCBS | OTHER |