Provider Demographics
NPI:1245305325
Name:GAONKAR, SAMEER (MD)
Entity type:Individual
Prefix:
First Name:SAMEER
Middle Name:
Last Name:GAONKAR
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 1:101 MAIN ST STE 116
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4530
Mailing Address - Country:US
Mailing Address - Phone:781-620-4894
Mailing Address - Fax:781-395-0759
Practice Address - Street 1:101 MAIN ST STE 116
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4530
Practice Address - Country:US
Practice Address - Phone:781-620-4894
Practice Address - Fax:781-395-0759
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212835207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA34547Medicare ID - Type Unspecified