Healthcare Provider Details

I. General information

NPI: 1114542297
Provider Name (Legal Business Name): DHRUVANSHU RAJENDRAKUMAR PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2020
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 ELECTRIC RD
SALEM VA
24153-7474
US

IV. Provider business mailing address

1900 ELECTRIC RD
SALEM VA
24153-7474
US

V. Phone/Fax

Practice location:
  • Phone: 540-444-2352
  • Fax:
Mailing address:
  • Phone: 540-444-2352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0116039902
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: