Basic Information
| Provider Information | |||||||||
| NPI: | 1932384955 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | AMISH | ||||||||
| MiddleName: | V. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 18563 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276198563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197821806 | ||||||||
| FaxNumber: | 9197824756 | ||||||||
| Practice Location | |||||||||
| Address1: | 3521 HAWORTH DR | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276097244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197821806 | ||||||||
| FaxNumber: | 9197824756 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2008 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036131956 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QG0300X | 2022-00800 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.