Individual
INDIRA MAHIDHARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
73D WINTHROP AVE, PLAZA 114, LAWRENCE, MA 01843-3716
(978) 686-3017
(978) 685-4280
Mailing address
73D WINTHROP AVE, PLAZA 114, LAWRENCE, MA 01843-3716
(978) 686-3017
(978) 685-4280
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
226631
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4147095
MVP HEALTH CARE
—
01
—
96223
FALLON COMM HEALTH PLAN
—
01
—
AA49793
HARVARD PILGRAM HLTH CARE
—
01
—
J27866
BLUE CARE ELECT
—
Enumeration date
05/12/2006
Last updated
07/08/2007
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