Individual
PAWARISSARA OSATHANUGRAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
85 E CONCORD ST, BOSTON, MA 02118-2335
(617) 414-4020
Mailing address
85 E CONCORD ST, BOSTON, MA 02118-2335
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
284761
MA
207W00000X
Ophthalmology Physician
ME166255
FL
207W00000X
Ophthalmology Physician
Primary
W1076
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128267600
—
FL
01
—
V5309
HFMG
FL
Enumeration date
04/02/2020
Last updated
11/26/2025
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