Provider Demographics
NPI:1477641462
Name:PATEL, JAYENDRAKUMAR I (MD)
Entity Type:Individual
Prefix:MR
First Name:JAYENDRAKUMAR
Middle Name:I
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 MALCOLM BLVD.
Mailing Address - Street 2:
Mailing Address - City:CONNELLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28612
Mailing Address - Country:US
Mailing Address - Phone:828-580-7655
Mailing Address - Fax:828-874-2278
Practice Address - Street 1:722 MALCOLM BLVD
Practice Address - Street 2:
Practice Address - City:CONNELLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28612
Practice Address - Country:US
Practice Address - Phone:828-580-7655
Practice Address - Fax:828-874-2278
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23417208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1477641462Medicaid
NC1477641462Medicaid
NC65955OtherBCBS
C85773Medicare UPIN
NC2327875Medicare PIN