Basic Information
| Provider Information | |||||||||
| NPI: | 1134298540 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAUDHARI | ||||||||
| FirstName: | SMITA | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KHERDE | ||||||||
| OtherFirstName: | SMITA | ||||||||
| OtherMiddleName: | S | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 47 HIGH ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | NORTH ANDOVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018452662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782584734 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 505 NASHUA RD STE 8 | ||||||||
| Address2: | |||||||||
| City: | DRACUT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018261929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789574474 | ||||||||
| FaxNumber: | 6035775644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 09/12/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 13322 | NH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 233181 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.