Healthcare Provider Details

I. General information

NPI: 1700470242
Provider Name (Legal Business Name): BHUMI PATEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 DUKE MEDICINE CIR # 3093
DURHAM NC
27710-2102
US

IV. Provider business mailing address

501 WILLARD ST APT 135
DURHAM NC
27701-3282
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-1817
  • Fax: 919-681-8147
Mailing address:
  • Phone: 919-356-2704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-11077
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: