Provider Demographics
NPI:1013048016
Name:PATEL, VINAY (MD)
Entity Type:Individual
Prefix:DR
First Name:VINAY
Middle Name:
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 1:410 THREE GREENS DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202
Mailing Address - Country:US
Mailing Address - Phone:803-422-9201
Mailing Address - Fax:
Practice Address - Street 1:1070 VINEHAVEN DR NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2438
Practice Address - Country:US
Practice Address - Phone:704-783-1840
Practice Address - Fax:704-783-1850
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-01530207R00000X
IAMD-46717207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201054960Medicaid
KY000000624697OtherANTHEM # WITH COOP HEALTH
KYK026641Medicare PIN
KY000000624697OtherANTHEM # WITH COOP HEALTH