Healthcare Provider Details

I. General information

NPI: 1649247537
Provider Name (Legal Business Name): DR. MAHESH R. BAJAJ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LIBERTY ST SUITE 307
SPRINGFIELD MA
01103-1114
US

IV. Provider business mailing address

125 LIBERTY ST SUITE 307
SPRINGFIELD MA
01103-1114
US

V. Phone/Fax

Practice location:
  • Phone: 413-781-1383
  • Fax: 413-732-3835
Mailing address:
  • Phone: 413-781-1383
  • Fax: 413-732-3835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number207K00000X
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: