Healthcare Provider Details

I. General information

NPI: 1386175214
Provider Name (Legal Business Name): JULIE BHARAT PATEL D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR RALEIGH BUILDING SUITE 304
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

269 W YORK ST APT 2503
NORFOLK VA
23510-1551
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-3397
  • Fax:
Mailing address:
  • Phone: 919-389-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0102206069
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: