MEDICARE: DR. TEDDI BACHAWATY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	246567	MA
2	207V00000X	Obstetrics & Gynecology Physician	307586	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154304228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TEDDI BACHAWATY MD

Provider Business Mailing Address
First Line	:	9 TROLLEY CROSSING RD
Second Line	:
City	:	CHARLTON
State	:	MA
Zip	:	01507-1351
Country	:	US
Telephone Number	:	508-980-7055
Fax Number	:	508-980-7072

Provider Business Practice Location Address
First Line	:	9 TROLLEY CROSSING RD
Second Line	:
City	:	CHARLTON
State	:	MA
Zip	:	01507
Country	:	US
Telephone Number	:	508-980-7055
Fax Number	:	508-980-7072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	03/12/2021

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