Healthcare Provider Details

I. General information

NPI: 1386087690
Provider Name (Legal Business Name): DHARA PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 09/26/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 LINCOLN ST STE 203
WORCESTER MA
01605-3646
US

IV. Provider business mailing address

18 WEDGEWOOD DR
HOPKINTON MA
01748-1180
US

V. Phone/Fax

Practice location:
  • Phone: 508-856-0200
  • Fax:
Mailing address:
  • Phone: 618-567-8575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number268827
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: