Provider Demographics
NPI:1376577833
Name:HOPE PSYCHIATRIC PLLC
Entity Type:Organization
Organization Name:HOPE PSYCHIATRIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUBHASH
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-854-9595
Mailing Address - Street 1:5029 CHESTNUT KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269
Mailing Address - Country:US
Mailing Address - Phone:704-596-7188
Mailing Address - Fax:704-596-7188
Practice Address - Street 1:438 E LONG AVE STE 1
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3500
Practice Address - Country:US
Practice Address - Phone:704-854-9595
Practice Address - Fax:704-852-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1267402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN01101OtherSC MEDICAID
NC5900720Medicaid
399184OtherVALUE OPTIONS
NC5900720Medicaid
SCN01101OtherSC MEDICAID