Healthcare Provider Details

I. General information

NPI: 1821551052
Provider Name (Legal Business Name): SHAIVYA PATHAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2019
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HOSPITAL DR
TARBORO NC
27886-2011
US

IV. Provider business mailing address

111 HOSPITAL DR
TARBORO NC
27886-2011
US

V. Phone/Fax

Practice location:
  • Phone: 252-641-7700
  • Fax:
Mailing address:
  • Phone: 252-641-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number202201777
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberRTL19-0853
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: