Healthcare Provider Details

I. General information

NPI: 1275975682
Provider Name (Legal Business Name): LAKSHMI MOHAN VIJI DAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 MAIN ST
BROCKTON MA
02301-4042
US

IV. Provider business mailing address

63 MAIN ST
BROCKTON MA
02301-4042
US

V. Phone/Fax

Practice location:
  • Phone: 508-559-6699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number1025218
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: