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General NPI Number Information
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NPI Number | 1114627650
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Entity Type | Individual
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Provider Name | KUSH GHANSHYAM PATEL PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/03/2023
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 233 BROAD ST STE 1
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City | MILFORD
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State | CT
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Zip | 06460-3549
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Country | US
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Telephone | 475-355-0962
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Fax |
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Provider Business Mailing Address
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Address Line | 233 BROAD ST STE 1
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City | MILFORD
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State | CT
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Zip | 06460-3549
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Country | US
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Telephone | 203-810-4151
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Fax | 203-783-9689
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 6471
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License Number State | CT
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