Healthcare Provider Details

I. General information

NPI: 1750470035
Provider Name (Legal Business Name): PHADKE AND PHADKE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST SUITE 585
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

123 SUMMER ST SUITE 585
WORCESTER MA
01608-1216
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-9030
  • Fax:
Mailing address:
  • Phone: 508-363-9030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number78071
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number80325
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier9724371
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: BHARATI JAYANT PHADKE
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 508-363-9030