Provider Demographics
NPI:1265413926
Name:MUDGAL, CHAITANYA (MD)
Entity type:Individual
Prefix:DR
First Name:CHAITANYA
Middle Name:
Last Name:MUDGAL
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:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-4700
Mailing Address - Fax:617-724-8532
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAW 2100
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153170207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ22899OtherBCBS MA
MA2086492Medicaid
MA750226OtherTUFTS HEALTH PLAN
MA2086492Medicaid
MAA31709Medicare ID - Type Unspecified