Provider Demographics
NPI:1629044102
Name:GOYAL, SANJEEV B (MD)
Entity Type:Individual
Prefix:
First Name:SANJEEV
Middle Name:B
Last Name:GOYAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3213
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01613-3213
Mailing Address - Country:US
Mailing Address - Phone:508-363-9052
Mailing Address - Fax:508-363-7104
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 635
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-363-9052
Practice Address - Fax:508-363-7104
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2014-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA158828207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherPRIVATE HEALTHCARE SYSTEM
MA637897OtherTUFTS
67548OtherFALLON COMMUNITY HEALTH
AA2846OtherHARVARD PILGRIM
1358263OtherFIRST HEALTH
784024OtherMVP HEALTH CARE
5009051OtherAETNA US HEALTHCARE
P00035681OtherRAILROAD MEDICARE
2501190OtherEVERCARE
MA2007304Medicaid
51145OtherCHILDRENS MED SECURITY
51145OtherHEALTHY START
6549987OtherCIGNA HEALTH PLAN
MA95651801OtherNETWORK HEALTH
042472266OtherONE HEALTH PLAN
A34250OtherMEDICARE B
MAM19460OtherBLUE CROSS BLUE SHIELD
MA2007304Medicaid
MAA34250Medicare ID - Type Unspecified