Provider Demographics
NPI:1932187846
Name:SADAGOPAN, ANDAL (MD)
Entity Type:Individual
Prefix:
First Name:ANDAL
Middle Name:
Last Name:SADAGOPAN
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 1:5 NEPONSET ST FL ST2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-368-5532
Mailing Address - Fax:508-616-4411
Practice Address - Street 1:900 UNION ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:508-871-0700
Practice Address - Fax:508-616-4411
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209816207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
784140OtherMVP HEALTH CARE
AA1292OtherHARVARD PILGRIM
A32802OtherMEDICARE B
0402312OtherEVERCARE
042472266OtherPRIVATE HEALTHCARE SYSTEM
J23700OtherBLUE SHIELD HMO BLUE
0150541OtherMEDICAID WELFARE
042472266OtherONE HEALTH PLAN
MA110004175AMedicaid
J23700OtherBLUE CARE ELECT
042472266OtherHEALTHCARE VALUE
110224092OtherRAILROAD MEDICARE
2044908OtherFIRST HEALTH
61237OtherFALLON COMMUNITY HEALTH
9481376OtherCIGNA HEALTH PLAN
0150541OtherHEALTHY START
7585340OtherAETNA US HEALTHCARE
J23700OtherBLUE SHIELD INDEMNITY
H44870Medicare UPIN
MAA32802Medicare ID - Type Unspecified