Provider Demographics
NPI:1750362950
Name:PATEL, MANISH GOVIND (MD)
Entity type:Individual
Prefix:
First Name:MANISH
Middle Name:GOVIND
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:650 SIGNAL HILL DRIVE EXT
Mailing Address - Street 2:PO BOX 1845
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-4353
Mailing Address - Country:US
Mailing Address - Phone:704-873-4277
Mailing Address - Fax:704-873-4511
Practice Address - Street 1:128 MEDICAL PARK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8578
Practice Address - Country:US
Practice Address - Phone:704-658-1001
Practice Address - Fax:704-658-1002
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2023-08-15
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Provider Licenses
StateLicense IDTaxonomies
NC200001518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912991Medicaid
NCH47935Medicare UPIN
NC8912991Medicaid
P00222931Medicare PIN