Healthcare Provider Details

I. General information

NPI: 1487072302
Provider Name (Legal Business Name): WORCESTER GASTROENTEROLOGY PARTNERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2014
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST 385
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

123 SUMMER ST 385
WORCESTER MA
01608-1216
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-7300
  • Fax: 508-363-9688
Mailing address:
  • Phone: 508-363-7300
  • Fax: 508-363-9688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number219686
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier1587072302
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerGROUP NPI

VIII. Authorized Official

Name: DR. CURUCHI P ANAND
Title or Position: INCORPORATOR/ CHIEF OFFICER
Credential: M.D
Phone: 774-288-9407