Healthcare Provider Details

I. General information

NPI: 1013313519
Provider Name (Legal Business Name): VANCE INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3624 EASTHAMPTON DR
GASTONIA NC
28056-8944
US

IV. Provider business mailing address

PO BOC 639295 DEPT 93394
CINCINNATI OH
45263-9295
US

V. Phone/Fax

Practice location:
  • Phone: 704-564-1312
  • Fax: 310-348-0201
Mailing address:
  • Phone: 484-346-1692
  • Fax: 855-618-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number200401558
License Number StateNC

VIII. Authorized Official

Name: DR. JIGNESH S PATEL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 704-564-1312