Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 234798 | MA |
Y | 111NI0900X | Internist | 234798 | MA |
NPI | 1003081985 |
---|---|
Provider Name | Rishi Bajaj |
First Address | Southbridge, MA 01550-0040 |
Second Address | Southbridge, MA 01550-4051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2008 |
Last Update Date | 29/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110080188A | (05) | MA |