Provider Demographics
NPI:1437147782
Name:DAGA, SEJAL (MD)
Entity Type:Individual
Prefix:
First Name:SEJAL
Middle Name:
Last Name:DAGA
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 1:100 HOSPITAL RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2253
Mailing Address - Country:US
Mailing Address - Phone:978-514-6300
Mailing Address - Fax:978-514-6324
Practice Address - Street 1:100 HOSPITAL RD
Practice Address - Street 2:SUITE 4
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2253
Practice Address - Country:US
Practice Address - Phone:978-514-6300
Practice Address - Fax:978-514-6324
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA217383208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2021510Medicaid
MAH93716Medicare UPIN
MA2021510Medicaid