Healthcare Provider Details

I. General information

NPI: 1376171082
Provider Name (Legal Business Name): POOJA PATAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2386 SPRINGS RD NE
HICKORY NC
28601-3066
US

IV. Provider business mailing address

2386 SPRINGS RD NE
HICKORY NC
28601-3066
US

V. Phone/Fax

Practice location:
  • Phone: 828-732-5400
  • Fax:
Mailing address:
  • Phone: 828-732-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2023026690
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2026-01602
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: