Provider Demographics
NPI:1912943176
Name:PATIL, VIJAY M (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:M
Last Name:PATIL
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 1:3 HIGH FIELDS DR
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-3452
Mailing Address - Country:US
Mailing Address - Phone:203-790-7480
Mailing Address - Fax:
Practice Address - Street 1:46 FEDERAL RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6129
Practice Address - Country:US
Practice Address - Phone:203-743-3877
Practice Address - Fax:203-743-1100
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016803208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1168038Medicaid
CTB39187Medicare UPIN
CT1168038Medicaid