Basic Information
| Provider Information | |||||||||
| NPI: | 1801860192 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAIN | ||||||||
| FirstName: | PREETI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 NEPONSET ST FL STREET2 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083685532 | ||||||||
| FaxNumber: | 5085952021 | ||||||||
| Practice Location | |||||||||
| Address1: | 378 MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | SHREWSBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015452673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085952513 | ||||||||
| FaxNumber: | 5085952021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2006 | ||||||||
| LastUpdateDate: | 03/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 213254 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 784240 | 01 | MVP HEALTH CARE | OTHER | AA1210 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | J24714 | 01 | BLUE SHIELD HMO BLUE | OTHER | 7537367 | 01 | AETNA US HEALTHCARE | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 1990558 | 01 | FIRST HEALTH | OTHER | J24714 | 01 | BLUE SHIELD INDEMNITY | OTHER | 0403366 | 01 | EVERCARE | OTHER | 168050 | 01 | WELFARE | OTHER | 7871454 | 01 | CIGNA HEALTH PLAN | OTHER | J24714 | 01 | BLUE CARE ELECT | OTHER | 168050 | 05 | MA | MEDICAID | A33806 | 01 | MEDICARE B | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | 110241681 | 01 | RAILROAL MEDICARE | OTHER | 168050 | 01 | MEDICAID PCC | OTHER | 043058466004 | 01 | TRICARE CHAMPUS | OTHER | 53067 | 01 | FALLON COMMUNITY HEALTH P | OTHER |