Healthcare Provider Details

I. General information

NPI: 1265611560
Provider Name (Legal Business Name): DEEP PATEL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 GLENWOOD AVE
RALEIGH NC
27608-2368
US

IV. Provider business mailing address

1514 GLENWOOD AVE
RALEIGH NC
27608-2368
US

V. Phone/Fax

Practice location:
  • Phone: 919-829-0076
  • Fax: 919-836-9094
Mailing address:
  • Phone: 919-829-0076
  • Fax: 919-942-0038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number548
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: