Provider Demographics
NPI:1720088321
Name:PATHAK, DHIREN (MD)
Entity Type:Individual
Prefix:
First Name:DHIREN
Middle Name:
Last Name:PATHAK
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 1:60 EAST ST
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-4500
Mailing Address - Country:US
Mailing Address - Phone:978-689-4601
Mailing Address - Fax:978-689-3086
Practice Address - Street 1:CARITAS HOLY FAMILY HOSPITAL
Practice Address - Street 2:70 EAST ST.
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844
Practice Address - Country:US
Practice Address - Phone:978-687-0151
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60090207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
30003655OtherNH WELFARE
780127OtherTUFT
MA3061043Medicaid
J09422OtherMASS BCBS
780127OtherTUFT
J09422Medicare ID - Type Unspecified