| Suhradam Medical Practice, Llc | |
|
50 Toll Gate Rd Berlin CT 06037-3606 | |
| (860) 438-6004 | |
| (860) 740-7103 |
| Full Name | Suhradam Medical Practice, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 50 Toll Gate Rd, Berlin, Connecticut |
| Authorized Official Name and Position | Brimal Babubhai Patel (CEO) |
| Authorized Official Contact | 8604386004 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Suhradam Medical Practice, Llc 50 Toll Gate Rd Berlin CT 06037-3606 Ph: (860) 438-6004 | Suhradam Medical Practice, Llc 50 Toll Gate Rd Berlin CT 06037-3606 Ph: (860) 438-6004 |
| NPI Number | 1932560281 |
|---|---|
| Provider Enumeration Date | 03/15/2016 |
| Last Update Date | 03/15/2016 |
| Medicare PECOS PAC ID | 7618260498 |
|---|---|
| Medicare Enrollment ID | O20160802000220 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932560281 | NPI | - | NPPES |
| 1083879522 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 049253 (Connecticut) | Primary |
| Provider Name | Brimal B Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083879522 PECOS PAC ID: 8426230467 Enrollment ID: I20110311000168 |
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