1255020715 NPI number — DR. MAITRI VIBHAS ACHAREKAR MD

Table of content: DR. MAITRI VIBHAS ACHAREKAR MD (NPI 1255020715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255020715 NPI number — DR. MAITRI VIBHAS ACHAREKAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ACHAREKAR
Provider First Name:
MAITRI
Provider Middle Name:
VIBHAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1255020715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BRG MID CITY MEDICINE CLINIC, 3401 NORTH BOULEVARD
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-387-7900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
732 HARRISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02118-2365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-414-5634
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2023

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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