=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144408212
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CUREWELL GASTROENTEROLOGY, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2008
-----------------------------------------------------
Last Update Date | 02/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 MEMORIAL DR SUITE 114
-----------------------------------------------------
City | LEOMINSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01453-2238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-466-4980
-----------------------------------------------------
Fax | 978-466-4980
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 MEMORIAL DR SUITE 114
-----------------------------------------------------
City | LEOMINSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01453-2238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-466-4980
-----------------------------------------------------
Fax | 978-466-4980
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | NAVEEN C PANDARABOYINA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 978-466-4980
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 228085
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------