Healthcare Provider Details

I. General information

NPI: 1710903430
Provider Name (Legal Business Name): MRUGENDRA RAOJIBHAI PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL PKWY STE 212
CHESAPEAKE VA
23320-4985
US

IV. Provider business mailing address

667 KINGSBOROUGH SQ STE 101
CHESAPEAKE VA
23320-4999
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-0508
  • Fax: 757-547-8963
Mailing address:
  • Phone: 757-842-4481
  • Fax: 757-312-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101041877
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: