Provider Demographics
NPI:1407881915
Name:VIRATA, MICHAEL DEAN (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DEAN
Last Name:VIRATA
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 1:1450 CHAPEL ST.
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4440
Mailing Address - Country:US
Mailing Address - Phone:203-789-4135
Mailing Address - Fax:203-789-4239
Practice Address - Street 1:HOSPITAL OF ST. RAPHAEL
Practice Address - Street 2:THE HAELEN CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4440
Practice Address - Country:US
Practice Address - Phone:203-789-4135
Practice Address - Fax:203-789-4239
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033619207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT033619OtherDPH-CT
3994957OtherDOJ
CT440000180Medicare PIN
3994957OtherDOJ
P00371268Medicare PIN