Provider Demographics
NPI:1043291107
Name:MISRA, MADHUSMITA (MD, MBBS)
Entity Type:Individual
Prefix:DR
First Name:MADHUSMITA
Middle Name:
Last Name:MISRA
Suffix:
Gender:F
Credentials:MD, MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-2909
Mailing Address - Fax:617-724-0581
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAW 6 PEDIATRIC ENDOCRINE ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-2909
Practice Address - Fax:617-726-5072
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159754208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0193089Medicaid
1879701 001OtherCIGNA PAL
204420OtherHPHC PBO
7285372OtherAETNA
MA159754OtherTUFTS HEALTH PLAN
MAJ24751OtherBCBS MA
1879701 001OtherCIGNA PAL
H59967Medicare UPIN