Provider Demographics
NPI:1275557738
Name:DHINGRA, JAGDISH K (MD)
Entity Type:Individual
Prefix:
First Name:JAGDISH
Middle Name:K
Last Name:DHINGRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PEARL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1195
Mailing Address - Country:US
Mailing Address - Phone:508-588-8034
Mailing Address - Fax:508-588-5969
Practice Address - Street 1:35 PEARL ST STE 100
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1195
Practice Address - Country:US
Practice Address - Phone:508-588-8034
Practice Address - Fax:508-588-5969
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2134622085U0001X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0195197Medicaid
MA0195197Medicaid
MAA33776Medicare PIN