Provider Demographics
NPI:1902966591
Name:PATEL, DHAVAL
Entity Type:Individual
Prefix:
First Name:DHAVAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:4515 PREMIER DRIVE
Practice Address - Street 2:SUITE 40
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8350
Practice Address - Country:US
Practice Address - Phone:336-802-2240
Practice Address - Fax:336-802-2241
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47488207R00000X
NC2009-00254207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5912729Medicaid
NC2073855AMedicare PIN