Basic Information
Provider Information
NPI: 1033764626
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NAGRA
FirstName: RAMNINDER
MiddleName: SINGH
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2165 DORCHESTER AVE APT D2
Address2:  
City: BOSTON
State: MA
PostalCode: 021245637
CountryCode: US
TelephoneNumber: 5055676129
FaxNumber:  
Practice Location
Address1: 2100 DORCHESTER AVE
Address2:  
City: DORCHESTER
State: MA
PostalCode: 021245615
CountryCode: US
TelephoneNumber: 6175062726
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/09/2019
LastUpdateDate: 08/09/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X280723MAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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