Healthcare Provider Details

I. General information

NPI: 1790465417
Provider Name (Legal Business Name): JASPAUL DHANOTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

IV. Provider business mailing address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

V. Phone/Fax

Practice location:
  • Phone: 252-332-3548
  • Fax: 252-332-1665
Mailing address:
  • Phone: 252-332-3548
  • Fax: 252-332-1665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRTL23-0483
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: