Provider Demographics
NPI:1710947106
Name:PATEL, ROSHNI (MD)
Entity Type:Individual
Prefix:
First Name:ROSHNI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SOUTH RD STE 120
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2022
Mailing Address - Country:US
Mailing Address - Phone:860-397-6179
Mailing Address - Fax:860-321-7148
Practice Address - Street 1:55 SOUTH RD STE 120
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2022
Practice Address - Country:US
Practice Address - Phone:860-397-6179
Practice Address - Fax:860-321-7148
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0424682084N0400X, 2084P0301X, 2084P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury Medicine
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3V1121OtherHEALTH NET
CT422008OtherWELLCARE MEDICARE ONLY
CT3212638OtherCIGNA
CT010042468CT02OtherBCBS, BCFP, MEDIBLUE
CT9932098OtherAETNA
CT001424689Medicaid
CT042468OtherCONNECTICARE
CT9932098OtherAETNA
CT042468OtherCONNECTICARE