Provider Demographics
NPI:1669449179
Name:PATEL, PRAVINKUMAR KANTILAL (MD)
Entity Type:Individual
Prefix:
First Name:PRAVINKUMAR
Middle Name:KANTILAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4140 FERNCREEK DR
Mailing Address - Street 2:FERNCREEK PRIMARY CARE, PC
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2563
Mailing Address - Country:US
Mailing Address - Phone:910-491-3922
Mailing Address - Fax:910-491-5350
Practice Address - Street 1:4140 FERNCREEK DR STE 501
Practice Address - Street 2:FERNCREEK PRIMARY CARE, PC
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2568
Practice Address - Country:US
Practice Address - Phone:910-491-3922
Practice Address - Fax:910-491-5350
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2016-06-15
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Provider Licenses
StateLicense IDTaxonomies
NC9501632207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1669449179Medicaid
11199OtherBCBS
G26090Medicare UPIN
11199OtherBCBS