Provider Demographics
NPI:1649381609
Name:VAGAL, DILIPKUMAR S (MD)
Entity type:Individual
Prefix:
First Name:DILIPKUMAR
Middle Name:S
Last Name:VAGAL
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 1:40 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-1138
Mailing Address - Country:US
Mailing Address - Phone:413-284-5400
Mailing Address - Fax:413-284-5114
Practice Address - Street 1:40 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1138
Practice Address - Country:US
Practice Address - Phone:413-284-5400
Practice Address - Fax:413-284-5114
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45495208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
100118OtherCIGNA
MA147575Medicaid
045495OtherCONNECTICARE
12-00989OtherUNITED HEALTH CARE
998293OtherNETWORK HEALTH PLAN
MAY02535OtherBLUECROSS/BLUESHIELD
045495OtherTUFTS COMMUNITY HLTH PLAN
201093OtherHARVARD PILGRIM HLTH CARE
351490OtherHEALTHSOURCE CMHC
25624OtherFALLON COMMUNITY HLTH PLA
045495OtherTUFTS COMMUNITY HLTH PLAN
100118OtherCIGNA