Healthcare Provider Details

I. General information

NPI: 1417030230
Provider Name (Legal Business Name): ASHOK VALJIBHAI PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/15/2024
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15110 JOHN J DELANEY DR STE 200
CHARLOTTE NC
28277-3544
US

IV. Provider business mailing address

PO BOX 19305
CHARLOTTE NC
28219-9305
US

V. Phone/Fax

Practice location:
  • Phone: 704-377-9323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number2010-01721
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2010-01721
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: