Provider Demographics
NPI:1114119377
Name:PATEL, DEEPTI (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPTI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEEPTI
Other - Middle Name:
Other - Last Name:DEV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:35 N HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2515
Mailing Address - Country:US
Mailing Address - Phone:201-323-0672
Mailing Address - Fax:
Practice Address - Street 1:3405 PENROSE PL STE 102
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1819
Practice Address - Country:US
Practice Address - Phone:973-937-8144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDD0093691202D00000X
NY266290208000000X, 2080P0208X
NJ25MA08510000208000000X
CODR0066167202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03521491Medicaid