Healthcare Provider Details

I. General information

NPI: 1912428608
Provider Name (Legal Business Name): DHAGASH PANKAJ PATEL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8305 FALLS OF NEUSE RD STE 100
RALEIGH NC
27615-3546
US

IV. Provider business mailing address

2000 PERIMETER PARK DR STE 200
MORRISVILLE NC
27560-8442
US

V. Phone/Fax

Practice location:
  • Phone: 919-846-1111
  • Fax: 919-846-1099
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number746
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: