MEDICARE: NITAL PATEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	0401417934	VA

General Provider Information

NPI Number	:	1396489811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NITAL PATEL

Provider Business Mailing Address
First Line	:	2521 N LANDING RD STE 100
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-3460
Country	:	US
Telephone Number	:	804-387-5977
Fax Number	:

Provider Business Practice Location Address
First Line	:	2521 N LANDING RD STE 100
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-3460
Country	:	US
Telephone Number	:	757-430-9448
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2022
Last Update Date	:	10/06/2022

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Directions to “ NITAL PATEL ” Practice Location

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