Basic Information
Provider Information
NPI: 1134228711
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATEL
FirstName: SONAL
MiddleName: RAMESH
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 508 FULTON ST
Address2: DURHAM VA MEDICAL CENTER
City: DURHAM
State: NC
PostalCode: 277053875
CountryCode: US
TelephoneNumber: 9192860411
FaxNumber: 9194165881
Practice Location
Address1: 508 FULTON ST
Address2: DURHAM VA MEDICAL CENTER
City: DURHAM
State: NC
PostalCode: 277053875
CountryCode: US
TelephoneNumber: 9192860411
FaxNumber: 9194165881
Other Information
ProviderEnumerationDate: 09/21/2006
LastUpdateDate: 04/21/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X036108290ILN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000X2012-02121NCY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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