Basic Information
| Provider Information | |||||||||
| NPI: | 1053705160 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAINALI | ||||||||
| FirstName: | PRAJEENA | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 TURNER CT | ||||||||
| Address2: | |||||||||
| City: | REHOBOTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027692128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037956334 | ||||||||
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| Practice Location | |||||||||
| Address1: | 203 PLYMOUTH AVE STE 701 | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027214300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022355445 | ||||||||
| FaxNumber: | 5082355594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2015 | ||||||||
| LastUpdateDate: | 10/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 277316 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.