1649381609 NPI number — DILIPKUMAR S VAGAL M.D.

Table of content: DILIPKUMAR S VAGAL M.D. (NPI 1649381609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649381609 NPI number — DILIPKUMAR S VAGAL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAGAL
Provider First Name:
DILIPKUMAR
Provider Middle Name:
S
Provider Name Prefix Text:
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:
1649381609
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 WRIGHT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01069-1138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-284-5400
Provider Business Mailing Address Fax Number:
413-284-5114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 WRIGHT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01069-1138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-284-5400
Provider Business Practice Location Address Fax Number:
413-284-5114
Provider Enumeration Date:
08/31/2006

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: 208000000X , with the licence number:  45495 , 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: 100118 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 147575 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 045495 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12-00989 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 998293 . This is a "NETWORK HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y02535 . This is a "BLUECROSS/BLUESHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 045495 . This is a "TUFTS COMMUNITY HLTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201093 . This is a "HARVARD PILGRIM HLTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 351490 . This is a "HEALTHSOURCE CMHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25624 . This is a "FALLON COMMUNITY HLTH PLA" identifier . This identifiers is of the category "OTHER".




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