Provider Demographics
NPI:1215903281
Name:PATEL, DILIPKUMAR N (MD)
Entity type:Individual
Prefix:
First Name:DILIPKUMAR
Middle Name:N
Last Name:PATEL
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 1:190 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:BROCHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302
Mailing Address - Country:US
Mailing Address - Phone:508-587-1960
Mailing Address - Fax:508-586-6160
Practice Address - Street 1:1 PEARL ST
Practice Address - Street 2:SUITE 1200
Practice Address - City:BROCHTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-588-3174
Practice Address - Fax:508-588-3179
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50497207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3024334Medicaid
MA3024334Medicaid
J06374Medicare ID - Type Unspecified