Healthcare Provider Details

I. General information

NPI: 1043969470
Provider Name (Legal Business Name): SANJIBAN DEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WOODLAND RD STE 213
STONEHAM MA
02180-1711
US

IV. Provider business mailing address

290 LITTLETON RD UNIT 3
CHELMSFORD MA
01824-3429
US

V. Phone/Fax

Practice location:
  • Phone: 781-662-7990
  • Fax:
Mailing address:
  • Phone: 978-258-4734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1024697
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: