Provider Demographics
NPI:1497930085
Name:INFECTIOUS DISEASES ASSOCIATES, PC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASES ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VENUGOPAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SADDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-689-2510
Mailing Address - Street 1:411 MERRIMACK ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5821
Mailing Address - Country:US
Mailing Address - Phone:978-689-2510
Mailing Address - Fax:978-689-3510
Practice Address - Street 1:411 MERRIMACK ST
Practice Address - Street 2:SUITE 201
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5821
Practice Address - Country:US
Practice Address - Phone:978-689-2510
Practice Address - Fax:978-689-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RI0200X
MA223439207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9787739Medicaid
MADN6781OtherRAIL ROAD MEDICARE
MA0004001Medicare PIN
MADN6781OtherRAIL ROAD MEDICARE