Healthcare Provider Details

I. General information

NPI: 1205540069
Provider Name (Legal Business Name): ASHUTOSH PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 01/06/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 FOX SPARROW RD
BECKLEY WV
25801-3687
US

IV. Provider business mailing address

24 FOX SPARROW RD
BECKLEY WV
25801-3687
US

V. Phone/Fax

Practice location:
  • Phone: 304-555-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: