Provider Demographics
NPI:1265458806
Name:MHATRE, JYOTSNA A (MD)
Entity Type:Individual
Prefix:
First Name:JYOTSNA
Middle Name:A
Last Name:MHATRE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:425 LAKE AVE N
Mailing Address - Street 2:STE 101
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2047
Mailing Address - Country:US
Mailing Address - Phone:508-753-3220
Mailing Address - Fax:508-753-3224
Practice Address - Street 1:425 LAKE AVE N
Practice Address - Street 2:STE 101
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2047
Practice Address - Country:US
Practice Address - Phone:508-753-3220
Practice Address - Fax:508-753-3224
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2019-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA418132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
041813OtherTUFTS COMMUNITY HEALTH PL
3547819OtherHEALTHSOURCE CMHC
J04655OtherBLUE CROSS BLUE SHIELD
MA3000389Medicaid
260028311OtherRAILROAD MEDICARE
984965OtherNETWORK HEALTH
220889OtherHARVARD PILGRIM
220889OtherHARVARD PILGRIM
A57945Medicare UPIN