Provider Demographics
NPI:1083932990
Name:PATEL-PRINEAS, MUKTI J (MD)
Entity Type:Individual
Prefix:
First Name:MUKTI
Middle Name:J
Last Name:PATEL-PRINEAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MUKTI
Other - Middle Name:JAYANT
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10 OVERLOOK RIDGE DR
Mailing Address - Street 2:APT 634
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-4711
Mailing Address - Country:US
Mailing Address - Phone:860-961-7786
Mailing Address - Fax:
Practice Address - Street 1:202 POMFRET ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1833
Practice Address - Country:US
Practice Address - Phone:860-963-7917
Practice Address - Fax:860-963-0018
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT53152207Q00000X, 208M00000X
OH35.121019207Q00000X
WA61179131207Q00000X
TXU1618207Q00000X
MA275034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist