Healthcare Provider Details

I. General information

NPI: 1649381609
Provider Name (Legal Business Name): DILIPKUMAR S VAGAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WRIGHT ST
PALMER MA
01069-1138
US

IV. Provider business mailing address

40 WRIGHT ST
PALMER MA
01069-1138
US

V. Phone/Fax

Practice location:
  • Phone: 413-284-5400
  • Fax: 413-284-5114
Mailing address:
  • Phone: 413-284-5400
  • Fax: 413-284-5114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number45495
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier100118
Identifier TypeOTHER
Identifier State
Identifier IssuerCIGNA
# 2
Identifier147575
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 3
Identifier045495
Identifier TypeOTHER
Identifier State
Identifier IssuerCONNECTICARE
# 4
Identifier12-00989
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITED HEALTH CARE
# 5
Identifier998293
Identifier TypeOTHER
Identifier State
Identifier IssuerNETWORK HEALTH PLAN
# 6
IdentifierY02535
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLUECROSS/BLUESHIELD
# 7
Identifier045495
Identifier TypeOTHER
Identifier State
Identifier IssuerTUFTS COMMUNITY HLTH PLAN
# 8
Identifier201093
Identifier TypeOTHER
Identifier State
Identifier IssuerHARVARD PILGRIM HLTH CARE
# 9
Identifier351490
Identifier TypeOTHER
Identifier State
Identifier IssuerHEALTHSOURCE CMHC
# 10
Identifier25624
Identifier TypeOTHER
Identifier State
Identifier IssuerFALLON COMMUNITY HLTH PLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: