Provider Demographics
NPI:1134147796
Name:PATEL, DIVYANG R (MD)
Entity type:Individual
Prefix:DR
First Name:DIVYANG
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2301 ROBESON ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5551
Mailing Address - Country:US
Mailing Address - Phone:910-484-4100
Mailing Address - Fax:910-484-4179
Practice Address - Street 1:2301 ROBESON ST
Practice Address - Street 2:SUITE 301
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5551
Practice Address - Country:US
Practice Address - Phone:910-484-4100
Practice Address - Fax:910-484-4179
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9501629207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8965867Medicaid
NC2230957Medicare ID - Type UnspecifiedMEDICARE ID
NC8965867Medicaid