Provider Demographics
NPI:1790483923
Name:SODNOMPIL, BAIGALMAA
Entity Type:Individual
Prefix:
First Name:BAIGALMAA
Middle Name:
Last Name:SODNOMPIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-0649
Mailing Address - Country:US
Mailing Address - Phone:781-308-6607
Mailing Address - Fax:
Practice Address - Street 1:36 COURTYARD PL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-1925
Practice Address - Country:US
Practice Address - Phone:781-308-6607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA374U00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA05Medicaid