Healthcare Provider Details

I. General information

NPI: 1710232012
Provider Name (Legal Business Name): SUBHASH PAUDEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST STE 380N
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

123 SUMMER ST STE 380N
WORCESTER MA
01608-1216
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-6126
  • Fax: 508-363-9266
Mailing address:
  • Phone: 508-363-6126
  • Fax: 508-363-9266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number278628
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: