Provider Demographics
NPI:1639134323
Name:BANA, DHIRENDRA SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:DHIRENDRA
Middle Name:SINGH
Last Name:BANA
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 1:19 ALHAMBRA RD
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1815
Mailing Address - Country:US
Mailing Address - Phone:617-325-9080
Mailing Address - Fax:
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:SUITE 5935 FAULKNER HOSPITAL
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3446
Practice Address - Country:US
Practice Address - Phone:617-524-3700
Practice Address - Fax:617-524-5839
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA035706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA035706OtherTUFTS
MA2002779Medicaid
MA6389OtherHARVARD PILGRIM
MAM17628OtherBLUECROSS BLUESHIELD
MAB75830Medicare UPIN