Healthcare Provider Details

I. General information

NPI: 1801250964
Provider Name (Legal Business Name): DEVESH ARUN PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR STE 204
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

600 GRESHAM DR STE 204
NORFOLK VA
23507-1904
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-5680
  • Fax: 757-388-5681
Mailing address:
  • Phone: 757-388-5680
  • Fax: 757-388-5681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT211646
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number0101271560
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: