Healthcare Provider Details

I. General information

NPI: 1538556055
Provider Name (Legal Business Name): RONAK R PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR STE 8630B
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

600 GRESHAM DR STE 8630B
NORFOLK VA
23507-1904
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-6115
  • Fax: 757-275-9998
Mailing address:
  • Phone: 757-388-6115
  • Fax: 757-275-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101269010
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0101269010
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: