MEDICARE: ASHOK NIMGADE, MD P.C.

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	261QR0400X	Rehabilitation Clinic/Center	154378	MA

General Provider Information

NPI Number	:	1467603480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHOK NIMGADE, MD P.C.

Provider Business Mailing Address
First Line	:	1458 DORCHESTER AVE
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02122-1343
Country	:	US
Telephone Number	:	617-282-8700
Fax Number	:	617-282-7400

Provider Business Practice Location Address
First Line	:	1458 DORCHESTER AVE
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02122-1343
Country	:	US
Telephone Number	:	617-282-8700
Fax Number	:	617-282-7400

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	EDNA VAZQUEZ
Credential	:
Telephone Number	:	617-282-8700

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	10/08/2008

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