Healthcare Provider Details

I. General information

NPI: 1194669945
Provider Name (Legal Business Name): VIRAJ SHAMIR PATEL MD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 EDGEHILL RD N
CHARLOTTE NC
28207-1885
US

IV. Provider business mailing address

1010 EDGEHILL RD N
CHARLOTTE NC
28207-1885
US

V. Phone/Fax

Practice location:
  • Phone: 704-468-0101
  • Fax: 704-355-5650
Mailing address:
  • Phone: 704-468-0101
  • Fax: 704-355-5650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: