Provider Demographics
NPI:1972572329
Name:ROYCHOWDHURY, ABHIJIT (MD)
Entity type:Individual
Prefix:
First Name:ABHIJIT
Middle Name:
Last Name:ROYCHOWDHURY
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 1:79 SAYLES ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-1729
Mailing Address - Country:US
Mailing Address - Phone:508-764-0482
Mailing Address - Fax:508-764-9410
Practice Address - Street 1:100 SOUTH ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-4051
Practice Address - Country:US
Practice Address - Phone:508-765-9771
Practice Address - Fax:508-764-9410
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2202232085N0904X, 2085R0001X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Not Answered2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA10621OtherHARVARD PILGRIM
MAJ27315OtherBLUE SHIELD
MA468845OtherTUFTS HEALTH PLAN
MD80784OtherFALLON COMMUNITY HLTH PLA
MAH70875Medicare UPIN
MAA36474Medicare ID - Type Unspecified
MD80784OtherFALLON COMMUNITY HLTH PLA