Provider Demographics
NPI:1750358222
Name:PATEL, SANDIP SUBHASHBHAI (MD)
Entity type:Individual
Prefix:
First Name:SANDIP
Middle Name:SUBHASHBHAI
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 41806
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309
Mailing Address - Country:US
Mailing Address - Phone:910-426-3332
Mailing Address - Fax:910-426-3340
Practice Address - Street 1:3653 CAPE CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-426-3332
Practice Address - Fax:910-426-3340
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11198OtherBCBS
NCB911198Medicaid
NCB911198Medicaid
11198OtherBCBS