Provider Demographics
NPI:1356302111
Name:PATEL, SURAHI (PA-C)
Entity type:Individual
Prefix:
First Name:SURAHI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2854
Mailing Address - Country:US
Mailing Address - Phone:704-638-6209
Mailing Address - Fax:
Practice Address - Street 1:11711 STATESVILLE BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:NC
Practice Address - Zip Code:27013-9418
Practice Address - Country:US
Practice Address - Phone:704-278-4053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1313363AS0400X
NC363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP1530Medicare ID - Type UnspecifiedMEDICARE NUMBER
MAP97071Medicare UPIN