Basic Information
| Provider Information | |||||||||
| NPI: | 1891903712 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHACHAR | ||||||||
| FirstName: | MUSHTAQUE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 MILL ROAD SUITE 180 | ||||||||
| Address2: | |||||||||
| City: | FAIRHAVEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027195252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089732000 | ||||||||
| FaxNumber: | 5089852001 | ||||||||
| Practice Location | |||||||||
| Address1: | 237 STATE RD | ||||||||
| Address2: | |||||||||
| City: | DARTMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027472612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087178903 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 04/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0012X | 231466 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00624517 | 01 | ND | RR MEDICARE | OTHER | 10671 | 01 | ND | LICENSE - ND | OTHER |