Provider Demographics
NPI:1417929076
Name:DASARI, SANDHYA R (MD)
Entity Type:Individual
Prefix:
First Name:SANDHYA
Middle Name:R
Last Name:DASARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MAIN ST
Mailing Address - Street 2:SUITE 210A
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-2919
Mailing Address - Country:US
Mailing Address - Phone:603-577-3080
Mailing Address - Fax:603-577-3081
Practice Address - Street 1:280 MAIN ST
Practice Address - Street 2:SUITE 210A
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2919
Practice Address - Country:US
Practice Address - Phone:603-577-3080
Practice Address - Fax:603-577-3081
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218117207R00000X
NH11902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
468613OtherTUFTS
0408579OtherUNITED HEALTH CARE
0927995001OtherCIGNA
3359902OtherAETNA
NHAA96670OtherHARVARD PILGRIM HEALTH CARE
NH000242201OtherMEDICARE ID TYPE UNSPECIFIED
NH30207030Medicaid
3359902OtherAETNA