Provider Demographics
NPI:1083879522
Name:PATEL, BRIMAL B (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIMAL
Middle Name:B
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 1:305 CHURCH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-2836
Mailing Address - Country:US
Mailing Address - Phone:203-729-0200
Mailing Address - Fax:203-729-8292
Practice Address - Street 1:305 CHURCH ST STE 1
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-2836
Practice Address - Country:US
Practice Address - Phone:203-729-0200
Practice Address - Fax:203-729-8292
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT49253207QS1201X, 207RS0012X
OH35.092352207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT49253OtherLICENSE