Provider Demographics
NPI:1962565135
Name:TEJWANI, NECHAL V (MD)
Entity type:Individual
Prefix:DR
First Name:NECHAL
Middle Name:V
Last Name:TEJWANI
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 1:6 ESSEX CENTER DRIVE
Mailing Address - Street 2:NORTH SHORE MEDICAL PARK
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960
Mailing Address - Country:US
Mailing Address - Phone:978-531-7671
Mailing Address - Fax:
Practice Address - Street 1:6 ESSEX CENTER DR
Practice Address - Street 2:NORTH SHORE MEDICAL PARK
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2910
Practice Address - Country:US
Practice Address - Phone:978-531-7671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA385702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA116871000OtherMAGELLAN
MAW05054OtherBLUE CROSS
MA116871000OtherMAGELLAN
MAD05054Medicare ID - Type UnspecifiedMEDICARE
MAW05054OtherBLUE CROSS