Basic Information
| Provider Information | |||||||||
| NPI: | 1932187846 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SADAGOPAN | ||||||||
| FirstName: | ANDAL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 NEPONSET ST FL ST2 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083685532 | ||||||||
| FaxNumber: | 5086164411 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 UNION ST | ||||||||
| Address2: | |||||||||
| City: | WESTBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088710700 | ||||||||
| FaxNumber: | 5086164411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2006 | ||||||||
| LastUpdateDate: | 04/12/2019 | ||||||||
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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 | 209816 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 784140 | 01 | MVP HEALTH CARE | OTHER | AA1292 | 01 | HARVARD PILGRIM | OTHER | A32802 | 01 | MEDICARE B | OTHER | 0402312 | 01 | EVERCARE | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | J23700 | 01 | BLUE SHIELD HMO BLUE | OTHER | 0150541 | 01 | MEDICAID WELFARE | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 110004175A | 05 | MA | MEDICAID | J23700 | 01 | BLUE CARE ELECT | OTHER | 042472266 | 01 | HEALTHCARE VALUE | OTHER | 110224092 | 01 | RAILROAD MEDICARE | OTHER | 2044908 | 01 | FIRST HEALTH | OTHER | 61237 | 01 | FALLON COMMUNITY HEALTH | OTHER | 9481376 | 01 | CIGNA HEALTH PLAN | OTHER | 0150541 | 01 | HEALTHY START | OTHER | 7585340 | 01 | AETNA US HEALTHCARE | OTHER | J23700 | 01 | BLUE SHIELD INDEMNITY | OTHER |