1285718148 NPI number — CHATTERJEE MEDICAL ASSOCIATES

Table of content: (NPI 1285718148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285718148 NPI number — CHATTERJEE MEDICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHATTERJEE MEDICAL ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1285718148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
451 ANDOVER ST
Provider Second Line Business Mailing Address:
SUITE G8
Provider Business Mailing Address City Name:
NO ANDOVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-975-0990
Provider Business Mailing Address Fax Number:
978-975-7803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
451 ANDOVER ST
Provider Second Line Business Practice Location Address:
SUITE G8
Provider Business Practice Location Address City Name:
NO ANDOVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-975-0990
Provider Business Practice Location Address Fax Number:
978-975-7803
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHATTERJEE
Authorized Official First Name:
SUDARSHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
978-975-0990

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  213420 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 210316 , 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: 3826032 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30214387 . This is a "EDS MEDICAID OF NH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 93030 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".
  • Identifier: M18961 . This is a "BCBS OF MASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9749390 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 93030 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".




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