Healthcare Provider Details

I. General information

NPI: 1942483706
Provider Name (Legal Business Name): KAMLESH P. PATEL M.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MEDICAL DR STE B
FAYETTEVILLE NC
28304-4425
US

IV. Provider business mailing address

PO BOX 87511
FAYETTEVILLE NC
28304-7511
US

V. Phone/Fax

Practice location:
  • Phone: 910-486-8080
  • Fax: 910-486-8090
Mailing address:
  • Phone: 910-486-8080
  • Fax: 910-486-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9601029
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number9601028
License Number StateNC

VIII. Authorized Official

Name: DR. HEMANGINI K PATEL
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 910-486-8080