Healthcare Provider Details

I. General information

NPI: 1710027156
Provider Name (Legal Business Name): SANJIV CHOPRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PARK DR LANDMARK CENTER, 2ND FLOOR WEST
BOSTON MA
02215-3325
US

IV. Provider business mailing address

401 PARK DR LANDMARK CENTER HMS CME 2ND FLOOR WEST
BOSTON MA
02215-3325
US

V. Phone/Fax

Practice location:
  • Phone: 617-384-8628
  • Fax: 617-998-1011
Mailing address:
  • Phone: 617-384-8628
  • Fax: 617-998-1014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number37573
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: