Healthcare Provider Details

I. General information

NPI: 1295087914
Provider Name (Legal Business Name): PARUL NAGAR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER STREET 587
WORCESTER MA
01608
US

IV. Provider business mailing address

123 SUMMER STREET STE 587
WORCESTER MA
01608
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-6470
  • Fax:
Mailing address:
  • Phone: 508-363-6470
  • Fax: 508-363-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number263168
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number263168
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier110105213
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: