Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 153170 | MA |
NPI | 1265413926 |
---|---|
Provider Name | Dr. Chaitanya Mudgal |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 31/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2086492 | (05) | MA |
750226 | TUFTS HEALTH PLAN (01) | MA |
H32067 | (02) | |
J22899 | BCBS MA (01) | MA |