Basic Information
| Provider Information | |||||||||
| NPI: | 1629041462 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAXENA | ||||||||
| FirstName: | SHEEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 409 W BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SOUTH BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021272245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172697500 | ||||||||
| FaxNumber: | 6174647512 | ||||||||
| Practice Location | |||||||||
| Address1: | 409 W BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SOUTH BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021272245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172697500 | ||||||||
| FaxNumber: | 6174647512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 12/15/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 221768 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0033964 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 7829699 | 01 | MA | CIGNA | OTHER | J28117 | 01 | MA | BLUE CROSS | OTHER | 000000028896 | 01 | MA | BMC HEALTHNET | OTHER | 467561 | 01 | MA | TUFTS HEALTH PLAN | OTHER | AA18472 | 01 | MA | HARVARD PILGRIM | OTHER | 467561 | 01 | MA | SECURE HORIZONS | OTHER |