Individual
MS. SREESUBHA P CHITTAMOORU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-0605
(508) 856-5074
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2665
CT
363A00000X
Physician Assistant
Primary
PA4578
MA
363AS0400X
Surgical Physician Assistant
2665
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110142188A
—
MA
Enumeration date
10/18/2011
Last updated
11/06/2024
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