Individual
GAUTAM GHANSHYAMBHAI PATEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 MATTHEWS TOWNSHIP PKWY, MATTHEWS, NC 28105-4656
(704) 384-5416
(704) 384-5992
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-5416
(704) 384-5992
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2010-01202
NC
207Q00000X
Family Medicine Physician
R1569
KY
208M00000X
Hospitalist Physician
Primary
2010-01202
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679764054
—
NC
01
—
NC0630D
MEDICARE PIN, INDIV UNDER CHG-WILKES
NC
Enumeration date
08/09/2007
Last updated
06/14/2023
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