Provider Demographics
NPI:1376560938
Name:PATEL, SANJAY D (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:D
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5213 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:919-620-4917
Mailing Address - Fax:919-620-4921
Practice Address - Street 1:11635 NORTHPARK DR
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6526
Practice Address - Country:US
Practice Address - Phone:919-570-6060
Practice Address - Fax:919-570-0404
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH9143207Q00000X
NC2011-01665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30006798Medicaid
C30428Medicare UPIN
NCNC2587AMedicare PIN
NHBX3783Medicare PIN