Healthcare Provider Details

I. General information

NPI: 1902646524
Provider Name (Legal Business Name): RADHA PATEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13808 PROFESSIONAL CENTER DR
HUNTERSVILLE NC
28078-7948
US

IV. Provider business mailing address

13808 PROFESSIONAL CENTER DR
HUNTERSVILLE NC
28078-7948
US

V. Phone/Fax

Practice location:
  • Phone: 704-377-4009
  • Fax:
Mailing address:
  • Phone: 704-377-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-15709
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5404
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: