Healthcare Provider Details

I. General information

NPI: 1679195366
Provider Name (Legal Business Name): KOMAL PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 LAKE BOONE TRL STE 201
RALEIGH NC
27607-7511
US

IV. Provider business mailing address

4201 LAKE BOONE TRL STE 201
RALEIGH NC
27607-7511
US

V. Phone/Fax

Practice location:
  • Phone: 919-785-0384
  • Fax: 919-785-0038
Mailing address:
  • Phone: 919-785-0384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2024-00162
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: