Provider Demographics
NPI:1023189891
Name:DAI, CHENGTA RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHENGTA
Middle Name:RICHARD
Last Name:DAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:C/O ST MARY'S HEALTH SYSTEM - PROVIDER ENROLLMENT
Mailing Address - Street 2:PO BOX 7291
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-7291
Mailing Address - Country:US
Mailing Address - Phone:207-777-8695
Mailing Address - Fax:207-777-8800
Practice Address - Street 1:168 KINSLEY STREET
Practice Address - Street 2:SUITE 20
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060
Practice Address - Country:US
Practice Address - Phone:603-578-9363
Practice Address - Fax:603-578-9539
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH6861207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3079372Medicaid
NH82100908Medicaid
392OtherCIGNA
042820258OtherHARVARD PILGRIM
22211OtherAETNA USHC
010090840NH01OtherANTHEM BC
NH82100908Medicaid
392OtherCIGNA