Provider Demographics
NPI:1437314325
Name:MARU, SANDIP T (MD)
Entity type:Individual
Prefix:DR
First Name:SANDIP
Middle Name:T
Last Name:MARU
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 1:2 HOSPITAL DR STE 2013
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-6632
Mailing Address - Country:US
Mailing Address - Phone:413-535-4785
Mailing Address - Fax:413-535-4786
Practice Address - Street 1:2 HOSPITAL DR STE 2013
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040
Practice Address - Country:US
Practice Address - Phone:413-535-4785
Practice Address - Fax:413-535-4786
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24914312086S0129X
MA2580112086S0129X
CT0498972086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT049897OtherCONNECTICARE
CT9120177OtherAETNA
CT2867521OtherCIGNA
CT9120177OtherAETNA