Healthcare Provider Details

I. General information

NPI: 1497004816
Provider Name (Legal Business Name): RAHUL A GANDHI MBBS, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

630 PLANTATION ST
WORCESTER MA
01605-2038
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-5000
  • Fax: 508-368-3146
Mailing address:
  • Phone: 508-852-0600
  • Fax: 508-368-3146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number250289
License Number StateMA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: