Provider Demographics
NPI:1376517102
Name:TRAPASSO, NIMMI (MD)
Entity Type:Individual
Prefix:DR
First Name:NIMMI
Middle Name:
Last Name:TRAPASSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIMMI
Other - Middle Name:
Other - Last Name:MENACHERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:372 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6202
Mailing Address - Country:US
Mailing Address - Phone:781-235-5200
Mailing Address - Fax:781-235-1103
Practice Address - Street 1:372 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-6202
Practice Address - Country:US
Practice Address - Phone:781-235-5200
Practice Address - Fax:781-235-1103
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21670OtherMEDICARE GROUP PROVIDER
MAI39981Medicare UPIN
MAM21670OtherMEDICARE GROUP PROVIDER