Provider Demographics
NPI:1285665935
Name:SAMNOTRA, VIVEK (MD)
Entity type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:
Last Name:SAMNOTRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6327
Mailing Address - Country:US
Mailing Address - Phone:508-383-8510
Mailing Address - Fax:508-383-8584
Practice Address - Street 1:99 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6327
Practice Address - Country:US
Practice Address - Phone:508-383-8510
Practice Address - Fax:508-383-8584
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11430207RX0202X
MA77090207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30201487Medicaid
VT0RE6183Medicare ID - Type Unspecified
NH30201487Medicaid
NHRE6183Medicare ID - Type Unspecified