Provider Demographics
NPI:1750965893
Name:SAHA, DEBAJYOTI
Entity type:Individual
Prefix:
First Name:DEBAJYOTI
Middle Name:
Last Name:SAHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 LAKE AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01655
Mailing Address - Country:US
Mailing Address - Phone:508-334-1131
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655
Practice Address - Country:US
Practice Address - Phone:508-334-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2025-06-12
Deactivation Date:2023-03-23
Deactivation Code:
Reactivation Date:2023-08-28
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA10220602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program