Provider Demographics
NPI:1457345803
Name:PATEL, DEVANG C (DPM)
Entity Type:Individual
Prefix:DR
First Name:DEVANG
Middle Name:C
Last Name:PATEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1008
Mailing Address - Country:US
Mailing Address - Phone:203-838-0442
Mailing Address - Fax:203-838-9431
Practice Address - Street 1:761 MAIN AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1080
Practice Address - Country:US
Practice Address - Phone:203-838-0442
Practice Address - Fax:203-838-9431
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000654213ES0103X, 213E00000X
CT0000654332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT752993094OtherTAX ID
CT752993094OtherTAX ID
480000884Medicare ID - Type Unspecified