Provider Demographics
NPI:1265611560
Name:PATEL, DEEP (DPM)
Entity type:Individual
Prefix:
First Name:DEEP
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-2368
Mailing Address - Country:US
Mailing Address - Phone:919-829-0076
Mailing Address - Fax:919-942-0038
Practice Address - Street 1:1514 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-2368
Practice Address - Country:US
Practice Address - Phone:919-829-0076
Practice Address - Fax:919-836-9094
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC548213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5915612Medicaid
NC2076649Medicare PIN