Healthcare Provider Details

I. General information

NPI: 1497190912
Provider Name (Legal Business Name): VIKALP PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 DIVISION ST
DERBY CT
06418-1326
US

IV. Provider business mailing address

130 DIVISION ST
DERBY CT
06418-1326
US

V. Phone/Fax

Practice location:
  • Phone: 203-732-1330
  • Fax: 203-732-1332
Mailing address:
  • Phone: 203-732-1330
  • Fax: 203-732-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number78926
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: