Basic Information
| Provider Information | |||||||||
| NPI: | 1336415348 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAMPAT | ||||||||
| FirstName: | HEMAL | ||||||||
| MiddleName: | NARENDRA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 FRUIT ST | ||||||||
| Address2: | BUL-015 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021142621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177243874 | ||||||||
| FaxNumber: | 6176431781 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 FRUIT ST | ||||||||
| Address2: | BUL-015 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021142621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177243874 | ||||||||
| FaxNumber: | 6176431781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2012 | ||||||||
| LastUpdateDate: | 07/29/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 266227 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 266227 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.