Healthcare Provider Details

I. General information

NPI: 1659357671
Provider Name (Legal Business Name): AMITA R CHOPRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 CAMBRIDGE ST
CAMBRIDGE MA
02138-4302
US

IV. Provider business mailing address

147 MILK ST PROVIDER ENROLLMENT - 9TH FLOOR
BOSTON MA
02109-4806
US

V. Phone/Fax

Practice location:
  • Phone: 617-661-5500
  • Fax: 617-661-5444
Mailing address:
  • Phone: 617-559-8053
  • Fax: 617-421-3487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38440
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: