Basic Information
| Provider Information | |||||||||
| NPI: | 1649381609 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAGAL | ||||||||
| FirstName: | DILIPKUMAR | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 WRIGHT ST | ||||||||
| Address2: | |||||||||
| City: | PALMER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010691138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132845400 | ||||||||
| FaxNumber: | 4132845114 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 WRIGHT ST | ||||||||
| Address2: | |||||||||
| City: | PALMER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010691138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132845400 | ||||||||
| FaxNumber: | 4132845114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 45495 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 100118 | 01 | CIGNA | OTHER | 147575 | 05 | MA | MEDICAID | 045495 | 01 | CONNECTICARE | OTHER | 12-00989 | 01 | UNITED HEALTH CARE | OTHER | 998293 | 01 | NETWORK HEALTH PLAN | OTHER | Y02535 | 01 | MA | BLUECROSS/BLUESHIELD | OTHER | 045495 | 01 | TUFTS COMMUNITY HLTH PLAN | OTHER | 201093 | 01 | HARVARD PILGRIM HLTH CARE | OTHER | 351490 | 01 | HEALTHSOURCE CMHC | OTHER | 25624 | 01 | FALLON COMMUNITY HLTH PLA | OTHER |