Provider Demographics
NPI:1467436055
Name:PHADKE, JAYANT GOPAL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYANT
Middle Name:GOPAL
Last Name:PHADKE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:123 SUMMER ST
Mailing Address - Street 2:STE 695
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1216
Mailing Address - Country:US
Mailing Address - Phone:508-363-5630
Mailing Address - Fax:508-363-5630
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:STE 695
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-363-5630
Practice Address - Fax:508-363-5630
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2012-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA0780712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3111083Medicaid
MAF67340Medicare UPIN
MAJ30127Medicare ID - Type UnspecifiedPHYSICIAN PROVIDER NUMBER