Provider Demographics
NPI:1629171756
Name:PATEL, PARTHSARTHI R (MD)
Entity Type:Individual
Prefix:
First Name:PARTHSARTHI
Middle Name:R
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 1:2288 BERLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-3206
Mailing Address - Country:US
Mailing Address - Phone:860-757-3575
Mailing Address - Fax:
Practice Address - Street 1:2288 BERLIN TPKE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3206
Practice Address - Country:US
Practice Address - Phone:860-757-3575
Practice Address - Fax:860-757-3576
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045268207P00000X, 207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080001954Medicare PIN
WVI35091Medicare UPIN