MEDICARE: TAPAN DILIPKUMAR PATEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	68709	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	68709	OTHER	CT	STATE OF CT

General Provider Information

NPI Number	:	1225424252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAPAN DILIPKUMAR PATEL M.D.

Provider Business Mailing Address
First Line	:	31 BROADWAY FL 2
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-2363
Country	:	US
Telephone Number	:	203-234-1324
Fax Number	:	203-239-3047

Provider Business Practice Location Address
First Line	:	31 BROADWAY FL 2
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-2363
Country	:	US
Telephone Number	:	203-234-1324
Fax Number	:	203-239-3047

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2015
Last Update Date	:	08/05/2021

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