Basic Information
Provider Information | |||||||||
NPI: | 1073718672 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BHATTACHARYYA | ||||||||
FirstName: | ROBY | ||||||||
MiddleName: | P | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD, PHD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | MASSACHUSETTS GENERAL HOSPITAL | ||||||||
Address2: | 55 FRUIT STREET | ||||||||
City: | BOSTON | ||||||||
State: | MA | ||||||||
PostalCode: | 02114 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6177263906 | ||||||||
FaxNumber: | 6177267653 | ||||||||
Practice Location | |||||||||
Address1: | 100 BLOSSOM ST | ||||||||
Address2: | MASSACHUSETTS GENERAL HOSPITAL, COX-5 | ||||||||
City: | BOSTON | ||||||||
State: | MA | ||||||||
PostalCode: | 021142606 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6177262066 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/15/2007 | ||||||||
LastUpdateDate: | 03/26/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | L-232301 | MA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RI0200X | 246877 | MA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.