Provider Demographics
NPI:1710935481
Name:PATEL, BHAVESH R (MD)
Entity Type:Individual
Prefix:
First Name:BHAVESH
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1579 STRAITS TURNPIKE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1836
Mailing Address - Country:US
Mailing Address - Phone:203-598-7246
Mailing Address - Fax:203-598-0200
Practice Address - Street 1:1579 STRAITS TPKE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-1835
Practice Address - Country:US
Practice Address - Phone:203-598-7246
Practice Address - Fax:203-598-0200
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2020-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT405932081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH67291Medicare UPIN
CT250000320Medicare ID - Type Unspecified