Provider Demographics
NPI:1417985698
Name:PATEL, SHITAL S (MD)
Entity Type:Individual
Prefix:
First Name:SHITAL
Middle Name:S
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S MAIN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-3359
Mailing Address - Country:US
Mailing Address - Phone:828-464-7770
Mailing Address - Fax:828-464-7775
Practice Address - Street 1:105 S MAIN AVE STE B
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3359
Practice Address - Country:US
Practice Address - Phone:828-464-7770
Practice Address - Fax:828-464-7775
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200901204207R00000X, 208000000X
NC2009-01204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173192902Medicaid
TXP00395998OtherMEDICARE RAILROAD
NCNC2700AMedicare Oscar/Certification
TX173192902Medicaid
TX8G5453Medicare PIN