Provider Demographics
NPI:1780675231
Name:NAGPAUL, KANTA (MD)
Entity type:Individual
Prefix:
First Name:KANTA
Middle Name:
Last Name:NAGPAUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 LEBANON STREET
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176
Mailing Address - Country:US
Mailing Address - Phone:781-665-4364
Mailing Address - Fax:
Practice Address - Street 1:3 WOODLAND RD
Practice Address - Street 2:SUITE 205
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1702
Practice Address - Country:US
Practice Address - Phone:781-662-2100
Practice Address - Fax:781-662-2284
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208000000X208000000X
MA2080P0202X2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2027321Medicaid
MA035189OtherTUFTS
MA20376OtherHARVARD PILGRIM HEALTH
MAB10154401OtherCIGNA
MAM08394OtherBLUE CROSS/BLUE SHIELD
MAM08394OtherBLUE CROSS/BLUE SHIELD