Provider Demographics
NPI:1649247537
Name:BAJAJ, MAHESH R
Entity type:Individual
Prefix:DR
First Name:MAHESH
Middle Name:R
Last Name:BAJAJ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LIBERTY ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1114
Mailing Address - Country:US
Mailing Address - Phone:413-781-1383
Mailing Address - Fax:413-732-3835
Practice Address - Street 1:125 LIBERTY ST
Practice Address - Street 2:SUITE 307
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1114
Practice Address - Country:US
Practice Address - Phone:413-781-1383
Practice Address - Fax:413-732-3835
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207K00000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAG24756Medicare UPIN