Individual
SANJAY MUDIGONDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2014 WASHINGTON STREET, NEWTON, MA 02462
(617) 243-6162
(207) 347-7401
Mailing address
PO BOX 417400, BOSTON, MA 02241-0001
(800) 360-4391
(770) 776-5702
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
221962
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2066262
—
MA
01
—
467604
TUFTS HEALTH CARE
MA
01
—
J28221
BLUE CROSS BLUE SHIELD
MA
Enumeration date
03/08/2006
Last updated
09/27/2011
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