Healthcare Provider Details

I. General information

NPI: 1699960856
Provider Name (Legal Business Name): MAHESH I PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MAHESHKUMAR ISHWARLAL PATEL M.D.

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST SOUTH 502/DIVISION OF HOSPITAL MEDICINE,CMG
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

2110 SILAS DEANE HWY
ROCKY HILL CT
06067
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-6230
  • Fax: 860-545-5221
Mailing address:
  • Phone: 860-258-3470
  • Fax: 860-571-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number046320
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberLT-2704
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA08308300
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number046320
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: