Healthcare Provider Details

I. General information

NPI: 1295743433
Provider Name (Legal Business Name): MUKESH P PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E BURWELL ST
SALEM VA
24153-4338
US

IV. Provider business mailing address

400 E BURWELL ST
SALEM VA
24153-4338
US

V. Phone/Fax

Practice location:
  • Phone: 540-387-3105
  • Fax: 540-387-3653
Mailing address:
  • Phone: 540-387-3105
  • Fax: 540-387-3653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101035881
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number0101035881
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: