Individual
DR. MADHUSMITA MISRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, MBBS
Contact information
Practice address
55 FRUIT ST, YAW 6 PEDIATRIC ENDOCRINE ASSOCIATES, BOSTON, MA 02114-2621
(617) 726-2909
(617) 726-5072
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 726-2909
(617) 724-0581
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
159754
MA
2080P0205X
Pediatric Endocrinology Physician
Primary
159754
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0193089
—
MA
01
—
159754
TUFTS HEALTH PLAN
MA
01
—
1879701 001
CIGNA PAL
—
01
—
204420
HPHC PBO
—
01
—
7285372
AETNA
—
01
—
J24751
BCBS MA
MA
Enumeration date
11/07/2005
Last updated
07/26/2012
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