Healthcare Provider Details

I. General information

NPI: 1043637176
Provider Name (Legal Business Name): BAIGALMAA ENKHTAIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 SANDWICH ST
PLYMOUTH MA
02360-2183
US

IV. Provider business mailing address

275 SANDWICH ST
PLYMOUTH MA
02360-2183
US

V. Phone/Fax

Practice location:
  • Phone: 508-830-2679
  • Fax: 508-830-2702
Mailing address:
  • Phone: 508-830-2679
  • Fax: 508-830-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.36160
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number292048
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number292048
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: