Healthcare Provider Details

I. General information

NPI: 1285665935
Provider Name (Legal Business Name): VIVEK SAMNOTRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 LINCOLN ST
FRAMINGHAM MA
01702-6327
US

IV. Provider business mailing address

99 LINCOLN ST
FRAMINGHAM MA
01702-6327
US

V. Phone/Fax

Practice location:
  • Phone: 508-383-8510
  • Fax: 508-383-8584
Mailing address:
  • Phone: 508-383-8510
  • Fax: 508-383-8584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number11430
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number77090
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: