Healthcare Provider Details

I. General information

NPI: 1033317052
Provider Name (Legal Business Name): KEDAR DESHPANDE MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 LINCOLN ST
FRAMINGHAM MA
01702-6358
US

IV. Provider business mailing address

115 LINCOLN ST
FRAMINGHAM MA
01702-6358
US

V. Phone/Fax

Practice location:
  • Phone: 508-383-1525
  • Fax:
Mailing address:
  • Phone: 508-383-1525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number216521
License Number StateMA

VIII. Authorized Official

Name: KEDAR S DESHPANDE
Title or Position: OWNER
Credential: MD
Phone: 508-383-1525