Basic Information
| Provider Information | |||||||||
| NPI: | 1558332551 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | UTPAL | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1249 KILDAIRE FARM RD | ||||||||
| Address2: | PMB 371 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275115523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9105619727 | ||||||||
| FaxNumber: | 8669500218 | ||||||||
| Practice Location | |||||||||
| Address1: | 812 CANDY PARK RD STE 6103 | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283729121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9105619727 | ||||||||
| FaxNumber: | 8669500218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2006 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 036115510 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | 2005-01380 | NC | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00235330 | 01 | NC | RAILROAD MEDICARE | OTHER | 5901602 | 05 | NC | MEDICAID | 140ET | 01 | NC | BCBS | OTHER |