Healthcare Provider Details

I. General information

NPI: 1780675231
Provider Name (Legal Business Name): KANTA NAGPAUL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WOODLAND RD SUITE 205
STONEHAM MA
02180-1702
US

IV. Provider business mailing address

548 LEBANON STREET
MELROSE MA
02176
US

V. Phone/Fax

Practice location:
  • Phone: 781-662-2100
  • Fax: 781-662-2284
Mailing address:
  • Phone: 781-665-4364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number208000000X
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number2080P0202X
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier2027321
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 2
Identifier035189
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS
# 3
Identifier20376
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerHARVARD PILGRIM HEALTH
# 4
IdentifierB10154401
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerCIGNA
# 5
IdentifierM08394
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLUE CROSS/BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: