Individual
XI NA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., PH.D.
Contact information
Practice address
3 WOODLAND ROAD, SUITE #312, STONEHAM, MA 02180
(781) 662-0604
(781) 665-4162
Mailing address
3 WOODLAND ROAD, SUITE #312, STONEHAM, MA 78166-4862
(781) 662-0604
(781) 665-4162
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
253157
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/04/2008
Last updated
10/15/2012
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