Provider Demographics
NPI:1770543977
Name:TRIVEDI, NITIN (MD)
Entity type:Individual
Prefix:DR
First Name:NITIN
Middle Name:
Last Name:TRIVEDI
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 1:250 HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-2584
Mailing Address - Country:US
Mailing Address - Phone:508-753-2060
Mailing Address - Fax:508-752-4244
Practice Address - Street 1:123 SUMMER STREET
Practice Address - Street 2:535
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608
Practice Address - Country:US
Practice Address - Phone:508-363-5189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218959207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
81124OtherFALLON
4570621OtherCIGNA
96610302OtherNETWORK HEALTH
467662OtherTUFTS
MA110041421AMedicaid
AA48173OtherHARVARD PILGRIM
J29562OtherBLUE SHIELD
MA110041421AMedicaid
81124OtherFALLON