1770543977 NPI number — DR. NITIN TRIVEDI M.D.

Table of content: DR. NITIN TRIVEDI M.D. (NPI 1770543977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770543977 NPI number — DR. NITIN TRIVEDI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRIVEDI
Provider First Name:
NITIN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1770543977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 HAMPTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01501-2584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-753-2060
Provider Business Mailing Address Fax Number:
508-752-4244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 SUMMER STREET
Provider Second Line Business Practice Location Address:
535
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-363-5189
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  218959 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 81124 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4570621 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 96610302 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 467662 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110041421A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA48173 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: J29562 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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