Provider Demographics
NPI:1407924798
Name:DASARI MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DASARI MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PADMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DASARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-784-9913
Mailing Address - Street 1:14 SANDPIPER WAY
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1536
Mailing Address - Country:US
Mailing Address - Phone:781-784-9913
Mailing Address - Fax:781-784-2368
Practice Address - Street 1:14 SANDPIPER WAY
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-1536
Practice Address - Country:US
Practice Address - Phone:781-784-9913
Practice Address - Fax:781-784-2368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3140466Medicaid
MA791424OtherTUFTS
MAM18858OtherBCBSMA GROUP
MA110055984AOtherMASS HEALTH
MA699999OtherHARVARD PILGRIM
MAM21524OtherMEDICARE GROUP
MADAA20200OtherBCBSMA
MAM21524OtherMEDICARE GROUP