1538135611 NPI number — BALTEJ S MAINI MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538135611 NPI number — BALTEJ S MAINI MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MAINI

Provider First Name:

BALTEJ

Provider Middle Name:

S

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1538135611

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

630 PLANTATION ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

WORCESTER

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

01605

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

508-368-5529

Provider Business Mailing Address Fax Number:

508-368-5530

Provider First Line Business Practice Location Address:

123 SUMMER ST

Provider Second Line Business Practice Location Address:

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:

508-368-3190

Provider Business Practice Location Address Fax Number:

508-368-3193

Provider Enumeration Date:

02/27/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2086S0129X , with the licence number:  38493 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 784047 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 9900024 . This is a "FALLON COMMUNITY HEALTH P" identifier . This identifiers is of the category "OTHER".
• Identifier: C07085 . This is a "BLUE SHIELD HMO BLUE" identifier . This identifiers is of the category "OTHER".
• Identifier: C07085 . This is a "BLUE SHIELD INDEMNITY" identifier . This identifiers is of the category "OTHER".
• Identifier: AA13526 . This is a "HARVARD PILGRIM HEALTHCAR" identifier . This identifiers is of the category "OTHER".
• Identifier: 26846 . This is a "CHILDRENS MEDICAL SECURIT" identifier . This identifiers is of the category "OTHER".
• Identifier: 917931 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: C07085 . This is a "MEDICARE B" identifier . This identifiers is of the category "OTHER".
• Identifier: C07085 . This is a "BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
• Identifier: 1700200 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 2041634 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 26846 . This is a "HEALTHY START" identifier . This identifiers is of the category "OTHER".
• Identifier: 7310881 . This is a "CIGNA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 2041634 . This is a "MEDICAID WELFARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 7156308 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".