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General NPI Number Information
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NPI Number | 1023169000
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Entity Type | Individual
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Provider Name | PATRICK RALPH FELICE M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 580 COTTAGE GROVE RD SUITE 103
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City | BLOOMFIELD
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State | CT
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Zip | 06002-3088
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Country | US
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Telephone | 860-242-0505
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Fax |
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Provider Business Mailing Address
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Address Line | 580 COTTAGE GROVE RD SUITE 103
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City | BLOOMFIELD
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State | CT
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Zip | 06002-3088
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Country | US
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Telephone | 860-242-0505
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 026480
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License Number State | CT
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