Healthcare Provider Details

I. General information

NPI: 1497950653
Provider Name (Legal Business Name): DEEPAK PATEL D. O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 JAHNKE RD SUITE 611
RICHMOND VA
23225-4017
US

IV. Provider business mailing address

14207 MEDINAH PL
CHESTER VA
23831-6589
US

V. Phone/Fax

Practice location:
  • Phone: 804-267-6607
  • Fax:
Mailing address:
  • Phone: 804-605-1058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116020839
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: