Provider Demographics
NPI:1013034727
Name:PATEL, JAY KRISHNAVADAN (MBCHB)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:KRISHNAVADAN
Last Name:PATEL
Suffix:
Gender:M
Credentials:MBCHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 NEW ST
Mailing Address - Street 2:CAROLINA KIDNEY ASSOCIATES
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3654
Mailing Address - Country:US
Mailing Address - Phone:336-379-9708
Mailing Address - Fax:336-553-2085
Practice Address - Street 1:309 NEW ST
Practice Address - Street 2:CAROLINA KIDNEY ASSOCIATES
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3654
Practice Address - Country:US
Practice Address - Phone:336-379-9708
Practice Address - Fax:336-553-2085
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC121946207R00000X
NC278088207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC56-1274347OtherCAROLINA KIDNEY'S TAX ID
NC5908623Medicaid
NCP00905301OtherRAILROAD MEDICARE
NC5908623Medicaid