Organization
CENTRAL MASS PEDIATRIC GI & NUTRITION, P.C.
Active
Organization
CENTRAL MASS PEDIATRIC GI & NUTRITION, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IDRIS DAHOD (PRESIDENT)
(508) 363-7344
Entity
Organization
Contact information
Practice address
123 SUMMER STREET, SUITE 630, WORCESTER, MA 01608
(508) 363-7344
Mailing address
PO BOX 1025, WORCESTER, MA 01613-1025
(508) 363-7344
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
156574
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3185796
—
MA
01
—
55515
FALLON
MA
01
—
691538
TUFTS
MA
01
—
M18069
BLUE CROSS BLUE SHIELD
MA
Enumeration date
02/13/2008
Last updated
02/13/2008
Update your record
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