Provider Demographics
NPI:1538135611
Name:MAINI, BALTEJ S (MD)
Entity Type:Individual
Prefix:
First Name:BALTEJ
Middle Name:S
Last Name:MAINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-368-5529
Mailing Address - Fax:508-368-5530
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608
Practice Address - Country:US
Practice Address - Phone:508-368-3190
Practice Address - Fax:508-368-3193
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA384932086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
784047OtherMVP HEALTH CARE
9900024OtherFALLON COMMUNITY HEALTH P
C07085OtherBLUE SHIELD HMO BLUE
C07085OtherBLUE SHIELD INDEMNITY
AA13526OtherHARVARD PILGRIM HEALTHCAR
26846OtherCHILDRENS MEDICAL SECURIT
917931OtherFIRST HEALTH
C07085OtherMEDICARE B
C07085OtherBLUE CARE ELECT
1700200OtherEVERCARE
MA2041634Medicaid
26846OtherHEALTHY START
7310881OtherCIGNA HEALTH PLAN
2041634OtherMEDICAID WELFARE
7156308OtherAETNA US HEALTHCARE
C07085OtherBLUE SHIELD HMO BLUE
MAC07085Medicare ID - Type Unspecified