Provider Demographics
NPI:1396779658
Name:PATEL, JAYANTKUMAR CHHOTABHAI (MD)
Entity type:Individual
Prefix:DR
First Name:JAYANTKUMAR
Middle Name:CHHOTABHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:132 MANSFIELD AVE
Mailing Address - Street 2:SUITE - 200
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2033
Mailing Address - Country:US
Mailing Address - Phone:860-456-2261
Mailing Address - Fax:860-450-1357
Practice Address - Street 1:132 MANSFIELD AVE
Practice Address - Street 2:SUITE-200
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2033
Practice Address - Country:US
Practice Address - Phone:860-456-2261
Practice Address - Fax:860-450-1357
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0205122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001205129Medicaid
D77070Medicare UPIN
CT001205129Medicaid