Provider Demographics
NPI:1114990652
Name:LAL, NIDHI K (MD)
Entity Type:Individual
Prefix:DR
First Name:NIDHI
Middle Name:K
Last Name:LAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:850 HARRISON AVE
Mailing Address - Street 2:YACC BN-C7
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-4001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 HARRISON AVE
Practice Address - Street 2:YACC 3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4001
Practice Address - Country:US
Practice Address - Phone:617-414-2080
Practice Address - Fax:617-414-2090
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
042881348OtherCHOICECARE
0034851OtherNEIGHBORHOOD HEALTH PLAN
92075OtherFALLON
AA25561OtherHARVARD PILGRIM HEALTH
467815OtherTUFTS
042881348OtherONE HEALTH
MA1305557Medicaid
3851718OtherAETNA
400681OtherCIGNA
967706OtherNETWORK HEALTH
J28429OtherBLUE CROSS BLUE SHIELD
042881348OtherBEECH STREET
042881348OtherUNICARE
2500794OtherUNITED HEALTH CARE
I24426Medicare UPIN
MA1305557Medicaid