Provider Demographics
NPI:1730116252
Name:NAGPAUL, CHANDER M (MD)
Entity Type:Individual
Prefix:
First Name:CHANDER
Middle Name:M
Last Name:NAGPAUL
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 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8374
Mailing Address - Fax:
Practice Address - Street 1:26 CITY HALL MALL
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4754
Practice Address - Country:US
Practice Address - Phone:781-306-5323
Practice Address - Fax:781-306-5387
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34379207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0082525OtherAETNA
MA60443OtherHARVARD PILGRIM
MA0016194OtherNEIGHBORHOOD HEALTH
MA724045OtherTUFTS
MA0174491Medicaid
MAM08271OtherBLUE CROSS
MAM08271OtherBLUE CROSS
MAA66060Medicare UPIN