Provider Demographics
NPI:1801806542
Name:SAMBANGI, NIRMALA (MD)
Entity type:Individual
Prefix:DR
First Name:NIRMALA
Middle Name:
Last Name:SAMBANGI
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 1:700 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-4396
Mailing Address - Country:US
Mailing Address - Phone:978-689-2400
Mailing Address - Fax:978-683-3424
Practice Address - Street 1:700 ESSEX ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-4396
Practice Address - Country:US
Practice Address - Phone:978-689-2400
Practice Address - Fax:978-683-3424
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL26382207Q00000X
MA233051207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000182501Medicare PIN
MA1801806542Medicare UPIN