Healthcare Provider Details

I. General information

NPI: 1457345803
Provider Name (Legal Business Name): DEVANG C PATEL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 MAIN AVE SUITE 106
NORWALK CT
06851-1080
US

IV. Provider business mailing address

488 MAIN AVE
NORWALK CT
06851-1008
US

V. Phone/Fax

Practice location:
  • Phone: 203-838-0442
  • Fax: 203-838-9431
Mailing address:
  • Phone: 203-838-0442
  • Fax: 203-838-9431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0000654
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000654
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000654
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: