Provider Demographics
NPI:1417915562
Name:JAIN, SANDEEP (MD)
Entity Type:Individual
Prefix:
First Name:SANDEEP
Middle Name:
Last Name:JAIN
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 1:330 BAKER AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2129
Mailing Address - Country:US
Mailing Address - Phone:978-287-9350
Mailing Address - Fax:978-287-9421
Practice Address - Street 1:330 BAKER AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2129
Practice Address - Country:US
Practice Address - Phone:978-287-9350
Practice Address - Fax:978-287-9421
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154343207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA154343OtherTUFTS
MA7718245OtherAETNA
MA3178897Medicaid
MA0738235-005OtherCIGNA
MAV763OtherHARVARD PILGRIM
MAJ18252OtherBLUE CROSS
MA7718245OtherAETNA
MAJ18252OtherBLUE CROSS