=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528358090
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHILPA MONGA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2011
-----------------------------------------------------
Last Update Date | 10/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 61 N MAIN ST
-----------------------------------------------------
City | CHARLTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01507-1315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-765-5981
-----------------------------------------------------
Fax | 508-764-4637
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 40
-----------------------------------------------------
City | SOUTHBRIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01550-0040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-909-7799
-----------------------------------------------------
Fax | 508-764-2432
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | 248838
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------