Provider Demographics
NPI:1992195333
Name:MUSTALI M DOHADWALA MD LLC
Entity type:Organization
Organization Name:MUSTALI M DOHADWALA MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSCIAN
Authorized Official - Prefix:
Authorized Official - First Name:MUSTALI
Authorized Official - Middle Name:
Authorized Official - Last Name:DOHADWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-688-2206
Mailing Address - Street 1:30 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5922
Mailing Address - Country:US
Mailing Address - Phone:978-688-2206
Mailing Address - Fax:978-683-6918
Practice Address - Street 1:30 HIGH STREET
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5922
Practice Address - Country:US
Practice Address - Phone:978-688-2206
Practice Address - Fax:978-683-6918
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEART SAFE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-23
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239299207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS40014339Medicare UPIN