Healthcare Provider Details

I. General information

NPI: 1609840461
Provider Name (Legal Business Name): STEPHANIE PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SYLVAN ST STE B102
DANVERS MA
01923-2764
US

IV. Provider business mailing address

75 SYLVAN ST STE B102
DANVERS MA
01923-2764
US

V. Phone/Fax

Practice location:
  • Phone: 978-774-7566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number230326
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number230326
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: