Healthcare Provider Details

I. General information

NPI: 1851603005
Provider Name (Legal Business Name): PRANEIL PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2010
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8375 DIX ELLIS TRL STE 201
JACKSONVILLE FL
32256-8241
US

IV. Provider business mailing address

PO BOX 63112
CHARLOTTE NC
28263-3112
US

V. Phone/Fax

Practice location:
  • Phone: 904-236-5884
  • Fax:
Mailing address:
  • Phone: 336-274-9617
  • Fax: 336-482-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number2020-03898
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2020-03898
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD464041
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME164565
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: