Healthcare Provider Details

I. General information

NPI: 1063423804
Provider Name (Legal Business Name): FEHMIDA A CHIPTY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 HIGH ST
MEDFORD MA
02155-3850
US

IV. Provider business mailing address

91 MONTVALE AVE
STONEHAM MA
02180-3623
US

V. Phone/Fax

Practice location:
  • Phone: 781-391-8015
  • Fax: 781-391-9119
Mailing address:
  • Phone: 781-828-3533
  • Fax: 781-828-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number154707
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: