Provider Demographics
NPI:1467633016
Name:ENDRIGA, RAUL B (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:B
Last Name:ENDRIGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:255 PARK AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1953
Mailing Address - Country:US
Mailing Address - Phone:508-754-8000
Mailing Address - Fax:508-752-8286
Practice Address - Street 1:255 PARK AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1953
Practice Address - Country:US
Practice Address - Phone:508-754-8000
Practice Address - Fax:508-752-8286
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA32162207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
A67990Medicare UPIN