Healthcare Provider Details

I. General information

NPI: 1245332667
Provider Name (Legal Business Name): SANGEETA S NADKARNI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MERRIMACK ST RIVERWALK
LAWRENCE MA
01843-1756
US

IV. Provider business mailing address

500 MERRIMACK ST RIVERWALK
LAWRENCE MA
01843-1756
US

V. Phone/Fax

Practice location:
  • Phone: 978-557-8900
  • Fax: 978-557-8867
Mailing address:
  • Phone: 978-557-8900
  • Fax: 978-557-8867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number226820
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier110083560A
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMASSHEALTH
# 2
Identifier1245332667
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerEVERCARE
# 3
Identifier30224106
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer
# 4
Identifier1245332667
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerAETNA HMO
# 5
IdentifierP00955490
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerRAILROAD MEDICARE
# 6
Identifier0468941
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerNEIGHBORHOOD HEALTH PLAN
# 7
Identifier8662203
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerCIGNA
# 8
Identifier9445361
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerAETNA NON HMO
# 9
Identifier1245332667
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLUE CROSS BLUE SHIELD
# 10
Identifier1245332667
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerFALLON COMMUNITY HEALTH PLAN
# 11
Identifier946887-01
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerNETWORK HEALTH
# 12
Identifier753648
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS
# 13
IdentifierAA154235
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerHARVARD PILGRIM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: