Provider Demographics
NPI:1144512179
Name:NAIDOO, LE SANTHA (DO)
Entity type:Individual
Prefix:
First Name:LE SANTHA
Middle Name:
Last Name:NAIDOO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 LITTLETON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3408
Mailing Address - Country:US
Mailing Address - Phone:978-323-0312
Mailing Address - Fax:978-323-0344
Practice Address - Street 1:198 LITTLETON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3408
Practice Address - Country:US
Practice Address - Phone:978-323-0312
Practice Address - Fax:978-323-0344
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA258192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400312302OtherMEDICARE PTAN
MAS400157107Medicare PIN