Provider Demographics
NPI:1982693974
Name:PATEL, PRASHANT KANU (MD)
Entity Type:Individual
Prefix:
First Name:PRASHANT
Middle Name:KANU
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 1:103 BAINES CT
Mailing Address - Street 2:STE 200
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6646
Mailing Address - Country:US
Mailing Address - Phone:919-467-6125
Mailing Address - Fax:919-467-1728
Practice Address - Street 1:103 BAINES CT
Practice Address - Street 2:STE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6646
Practice Address - Country:US
Practice Address - Phone:919-467-6125
Practice Address - Fax:919-467-1728
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800658207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891174RMedicaid
G89014Medicare UPIN
NC891174RMedicaid