Provider Demographics
NPI:1992835540
Name:PATEL, PADMAVATI A (MD)
Entity type:Individual
Prefix:DR
First Name:PADMAVATI
Middle Name:A
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1461 SOUTHBRITAIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-0901
Mailing Address - Country:US
Mailing Address - Phone:203-586-2390
Mailing Address - Fax:203-586-2701
Practice Address - Street 1:1461 SOUTHBRITAIN RD
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-0901
Practice Address - Country:US
Practice Address - Phone:203-586-2390
Practice Address - Fax:203-586-2701
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038839207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH24075Medicare UPIN