Provider Demographics
NPI:1861597254
Name:HARATI, NIBAL A (MD)
Entity type:Individual
Prefix:
First Name:NIBAL
Middle Name:A
Last Name:HARATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:95 TREMONT ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-4738
Mailing Address - Country:US
Mailing Address - Phone:781-934-0060
Mailing Address - Fax:781-934-7006
Practice Address - Street 1:205 PARKINGWAY
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:617-820-5968
Practice Address - Fax:833-471-5603
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2024-08-05
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Provider Licenses
StateLicense IDTaxonomies
MA230063207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2127172Medicaid
MA495429OtherTUFTS HEALTH PLAN
MA491600OtherUS FAMILY HEALTH
MAJ40839OtherBLUE CROSS BLUE SHIELD
MA000000036507OtherBMC HEALTHNET
MAAA73517OtherHARVARD PILGRIM
MAJ40839OtherBLUE CROSS BLUE SHIELD
MAAA73517OtherHARVARD PILGRIM