Provider Demographics
NPI:1023226107
Name:DILWALI, PRADEEP (MD)
Entity type:Individual
Prefix:DR
First Name:PRADEEP
Middle Name:
Last Name:DILWALI
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 1:1358 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-3821
Mailing Address - Country:US
Mailing Address - Phone:781-860-0255
Mailing Address - Fax:781-860-9393
Practice Address - Street 1:1358 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-3821
Practice Address - Country:US
Practice Address - Phone:781-860-0255
Practice Address - Fax:781-860-9393
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57583207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3020690Medicaid
MA3020690Medicaid
MAJ06240Medicare ID - Type Unspecified