Provider Demographics
NPI:1821103938
Name:PATEL, ANITHA J (MD)
Entity Type:Individual
Prefix:
First Name:ANITHA
Middle Name:J
Last Name:PATEL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3715 MAIN STREET
Mailing Address - Street 2:SUITE 309
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606
Mailing Address - Country:US
Mailing Address - Phone:203-372-4211
Mailing Address - Fax:203-372-4142
Practice Address - Street 1:3715 MAIN STREET
Practice Address - Street 2:SUITE 309
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606
Practice Address - Country:US
Practice Address - Phone:203-372-4211
Practice Address - Fax:203-372-4142
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CT035459207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010035459CT01OtherANTHEM BLUE CROSS
CT0V6126OtherHEALTHNET
CT0V6126OtherHEALTHNET