1114990652 NPI number — DR. NIDHI K LAL MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114990652 NPI number — DR. NIDHI K LAL MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LAL

Provider First Name:

NIDHI

Provider Middle Name:

K

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1114990652

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/31/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

850 HARRISON AVE

Provider Second Line Business Mailing Address:

YACC BN-C7

Provider Business Mailing Address City Name:

BOSTON

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

02118-4001

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

850 HARRISON AVE

Provider Second Line Business Practice Location Address:

YACC 3

Provider Business Practice Location Address City Name:

BOSTON

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

02118-4001

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

617-414-2080

Provider Business Practice Location Address Fax Number:

617-414-2090

Provider Enumeration Date:

02/07/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  221326 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 042881348 . This is a "CHOICECARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 0034851 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 92075 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".
• Identifier: AA25561 . This is a "HARVARD PILGRIM HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 467815 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
• Identifier: 042881348 . This is a "ONE HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 1305557 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 3851718 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 400681 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 967706 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: J28429 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 042881348 . This is a "BEECH STREET" identifier . This identifiers is of the category "OTHER".
• Identifier: 042881348 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 2500794 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".