Individual
SURESH GUNDAJI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS
Contact information
Practice address
110 LIBERTY ST, SIGNATURE HEALTHCARE, BROCKTON, MA 02301-5521
(508) 894-0400
(508) 894-0412
Mailing address
110 LIBERTY ST, SIGNATURE HEALTHCARE, BROCKTON, MA 02301-5521
(508) 894-0400
(508) 894-0412
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
257064
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07814
—
LA
Enumeration date
05/23/2007
Last updated
01/12/2024
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