Healthcare Provider Details

I. General information

NPI: 1902996572
Provider Name (Legal Business Name): MOHIT PAWAN CHOPRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/27/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 SAVIN ST SUITE 200
MALDEN MA
02148-2329
US

IV. Provider business mailing address

180 SOUTH ST
CHESTNUT HILL MA
02467-3666
US

V. Phone/Fax

Practice location:
  • Phone: 781-338-7250
  • Fax: 781-338-7245
Mailing address:
  • Phone: 781-708-3832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE-4231
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberE-4231
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number238370
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number238370
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: