Healthcare Provider Details

I. General information

NPI: 1396779658
Provider Name (Legal Business Name): JAYANTKUMAR CHHOTABHAI PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 MANSFIELD AVE SUITE-200
WILLIMANTIC CT
06226-2033
US

IV. Provider business mailing address

132 MANSFIELD AVE SUITE - 200
WILLIMANTIC CT
06226-2033
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-2261
  • Fax: 860-450-1357
Mailing address:
  • Phone: 860-456-2261
  • Fax: 860-450-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number020512
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: