1336164359 NPI number — MITAL M PATEL MD

Table of content: MITAL M PATEL MD (NPI 1336164359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336164359 NPI number — MITAL M PATEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
MITAL
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DALSANIA
Provider Other First Name:
MITAL
Provider Other Middle Name:
PARAG
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336164359
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
809 WANDERING WAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAXHAW
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28173-7016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-401-5540
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 BRENNER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28144-2515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-638-9000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  200600800 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: N0080H , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5904390 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NCA219A . This is a "MEDICARE PIN, INDIVIDUAL FOR CMC-NORTHEAST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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