Healthcare Provider Details

I. General information

NPI: 1851442677
Provider Name (Legal Business Name): JAIMITA V PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 MEDICAL DR
ANGIER NC
27501-6087
US

IV. Provider business mailing address

PO DRAWER B, HWY 421 1000 MEDICAL CENTER ROAD
MAMERS NC
27552
US

V. Phone/Fax

Practice location:
  • Phone: 919-639-2122
  • Fax: 919-639-8685
Mailing address:
  • Phone: 910-893-5402
  • Fax: 910-893-2567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2006-01781
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: