Basic Information
| Provider Information | |||||||||
| NPI: | 1952568834 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | DIPAK | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 419 SCARBOROUGH LN | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064577551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169932847 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 134 STATE ST | ||||||||
| Address2: | |||||||||
| City: | MERIDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064503293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032372229 | ||||||||
| FaxNumber: | 2036861766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2008 | ||||||||
| LastUpdateDate: | 04/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 04/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 047386 | CT | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 47386 | CT | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | 47386 | CT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 004236346 | 05 | CT | MEDICAID |