Provider Demographics
NPI:1942221775
Name:JAIN, MUKESH (MD)
Entity type:Individual
Prefix:
First Name:MUKESH
Middle Name:
Last Name:JAIN
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 1:20 BLOSSOM ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-8110
Mailing Address - Country:US
Mailing Address - Phone:617-278-0175
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:BWH CARDIOVASCULAR DIV
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-278-0175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78028207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00432700OtherRAILROAD MEDICARE
OH363664OtherWELLCARE
OH000000539506OtherANTHEM
OH743245OtherBUCKEYE
OH2683332Medicaid
OH7013147OtherAETNA
OH000000224379OtherUNISON
OH2683332Medicaid