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General NPI Number Information
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NPI Number | 1912914102
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Entity Type | Individual
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Provider Name | BAKUL KUMAR PATEL
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 1129 N MAIN ST STE G
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-2547
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Country | US
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Telephone | 434-572-8196
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Fax | 434-572-8341
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Provider Business Mailing Address
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Address Line | 1129 N MAIN ST STE G
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-2547
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Country | US
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Telephone | 345-728-1964
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Fax | 434-572-8341
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 101234858
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 2013-00007
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License Number State | NC
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