Provider Demographics
NPI:1699743427
Name:ZUTSHI, MADAN LAL (MD)
Entity type:Individual
Prefix:
First Name:MADAN
Middle Name:LAL
Last Name:ZUTSHI
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 1:92 GARLAND ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149
Mailing Address - Country:US
Mailing Address - Phone:617-389-6033
Mailing Address - Fax:617-389-2644
Practice Address - Street 1:92 GARLAND ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149
Practice Address - Country:US
Practice Address - Phone:617-389-6033
Practice Address - Fax:617-389-2644
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36320207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2033739Medicaid
A68142Medicare UPIN
MA2033739Medicaid