Healthcare Provider Details

I. General information

NPI: 1720048457
Provider Name (Legal Business Name): PRAFUL PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 09/25/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 PHYSICIANS DR
WILMINGTON NC
28401-7338
US

IV. Provider business mailing address

PO BOX 19305
CHARLOTTE NC
28219-9305
US

V. Phone/Fax

Practice location:
  • Phone: 910-662-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number39056
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: