Basic Information
| Provider Information | |||||||||
| NPI: | 1861597254 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARATI | ||||||||
| FirstName: | NIBAL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 TREMONT ST | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | DUXBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023324738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819340060 | ||||||||
| FaxNumber: | 7819347006 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 TREMONT ST | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | DUXBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023324738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819340060 | ||||||||
| FaxNumber: | 7819347006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 11/29/2007 | ||||||||
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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 | 230063 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000036507 | 01 | MA | BMC HEALTHNET | OTHER | 495429 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 491600 | 01 | MA | US FAMILY HEALTH | OTHER | 2127172 | 05 | MA | MEDICAID | J40839 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER | AA73517 | 01 | MA | HARVARD PILGRIM | OTHER |