Healthcare Provider Details

I. General information

NPI: 1831398452
Provider Name (Legal Business Name): BADRISH JAYANTI PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PENNS WAY SUITE 407
NEW CASTLE DE
19720-2407
US

IV. Provider business mailing address

4745 OGLETOWN STANTON RD SUITE 220
NEWARK DE
19713-2067
US

V. Phone/Fax

Practice location:
  • Phone: 302-613-5080
  • Fax: 302-328-7313
Mailing address:
  • Phone: 302-368-5515
  • Fax: 302-266-6168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME99306
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC1-0008634
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: