Healthcare Provider Details

I. General information

NPI: 1487281143
Provider Name (Legal Business Name): VISHAL PATEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 CHESTNUT RIDGE RD
MORGANTOWN WV
26505-2807
US

IV. Provider business mailing address

201 DOWMAN DR NE
ATLANTA GA
30322-1061
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-6400
  • Fax:
Mailing address:
  • Phone:
  • 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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberPENDING
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: