Provider Demographics
NPI:1790785020
Name:PATEL, KAMLESH PANUBHAI (MD)
Entity Type:Individual
Prefix:
First Name:KAMLESH
Middle Name:PANUBHAI
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:PO BOX 87511
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-7511
Mailing Address - Country:US
Mailing Address - Phone:910-486-8080
Mailing Address - Fax:910-486-8090
Practice Address - Street 1:1301 MEDICAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4425
Practice Address - Country:US
Practice Address - Phone:910-486-8080
Practice Address - Fax:910-486-8090
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-01029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2335759OtherMEDICARE GROUP NUMBER
65846OtherBCBS NC
NC8965846Medicaid
NC2230883COtherMEDICARE INDIVIDUAL NUMBE
5892258OtherAETNA
5892258OtherAETNA