Provider Demographics
NPI:1770584492
Name:PAHUJA, KESHAUDAS (MD)
Entity type:Individual
Prefix:
First Name:KESHAUDAS
Middle Name:
Last Name:PAHUJA
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 1:966B PARK ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3650
Mailing Address - Country:US
Mailing Address - Phone:781-344-4400
Mailing Address - Fax:781-344-6956
Practice Address - Street 1:966B PARK ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3650
Practice Address - Country:US
Practice Address - Phone:781-344-4400
Practice Address - Fax:781-344-6956
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA46201208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0110698Medicaid
MA0110698Medicaid
A53876Medicare UPIN
MAC23050Medicare ID - Type Unspecified