Healthcare Provider Details

I. General information

NPI: 1164614517
Provider Name (Legal Business Name): MADHAB RAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

680 CENTRE ST
BROCKTON MA
02302-3308
US

V. Phone/Fax

Practice location:
  • Phone: 855-776-4224
  • Fax:
Mailing address:
  • Phone: 508-941-7299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number243686
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number243686
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number243686
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: