Provider Demographics
NPI:1285718148
Name:CHATTERJEE MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:CHATTERJEE MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUDARSHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHATTERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-975-0990
Mailing Address - Street 1:451 ANDOVER ST
Mailing Address - Street 2:SUITE G8
Mailing Address - City:NO ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845
Mailing Address - Country:US
Mailing Address - Phone:978-975-0990
Mailing Address - Fax:978-975-7803
Practice Address - Street 1:451 ANDOVER ST
Practice Address - Street 2:SUITE G8
Practice Address - City:NO ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845
Practice Address - Country:US
Practice Address - Phone:978-975-0990
Practice Address - Fax:978-975-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213420207R00000X
MA210316207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3826032OtherAETNA
30214387OtherEDS MEDICAID OF NH
93030OtherFALLON
M18961OtherBCBS OF MASS
MA9749390Medicaid
93030OtherTUFTS
93030OtherFALLON
=========OtherFIRST HEALTH
=========OtherMULTIPLANS
=========OtherTAX ID #
=========OtherHARVARD PILGRAM
=========OtherCIGNA
M18961OtherBCBS OF MASS
MA9749390Medicaid
30214387OtherEDS MEDICAID OF NH