Basic Information
| Provider Information | |||||||||
| NPI: | 1225424252 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | TAPAN | ||||||||
| MiddleName: | DILIPKUMAR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 BROADWAY FL 2 | ||||||||
| Address2: | |||||||||
| City: | NORTH HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064732363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032341324 | ||||||||
| FaxNumber: | 2032393047 | ||||||||
| Practice Location | |||||||||
| Address1: | 31 BROADWAY FL 2 | ||||||||
| Address2: | |||||||||
| City: | NORTH HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064732363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032341324 | ||||||||
| FaxNumber: | 2032393047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2015 | ||||||||
| LastUpdateDate: | 08/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 68709 | CT | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 68709 | 01 | CT | STATE OF CT | OTHER |