Basic Information
Provider Information
NPI: 1073680716
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOOKHRAN
FirstName: DHANESH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
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: 40 WRIGHT ST
Address2:  
City: PALMER
State: MA
PostalCode: 010691138
CountryCode: US
TelephoneNumber: 4132848761
FaxNumber: 4132845117
Other Information
ProviderEnumerationDate: 11/29/2006
LastUpdateDate: 04/25/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X226800MAY Allopathic & Osteopathic PhysiciansHospitalist 
207R00000X226800MAN Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


Home