Basic Information
Provider Information
NPI: 1700878188
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAKSHI
FirstName: MADHURITA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 280 CHESTNUT ST
Address2: 2ND FLOOR
City: SPRINGFIELD
State: MA
PostalCode: 011991001
CountryCode: US
TelephoneNumber: 4137945700
FaxNumber:  
Practice Location
Address1: 164 HIGH ST
Address2:  
City: GREENFIELD
State: MA
PostalCode: 013012613
CountryCode: US
TelephoneNumber: 4137720211
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/22/2005
LastUpdateDate: 07/08/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X254515MAN Allopathic & Osteopathic PhysiciansHospitalist 
207R00000X254515MAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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