Provider Demographics
NPI:1558713065
Name:ESA, NADA (MD)
Entity Type:Individual
Prefix:
First Name:NADA
Middle Name:
Last Name:ESA
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 1:26 OLD STOCKBRIDGE RD
Mailing Address - Street 2:P.O 43
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240
Mailing Address - Country:US
Mailing Address - Phone:508-733-7537
Mailing Address - Fax:
Practice Address - Street 1:26 OLD STOCKBRIDGE RD
Practice Address - Street 2:P.O 43
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240
Practice Address - Country:US
Practice Address - Phone:508-733-7537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA268241207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine