Individual
PRAVEEN B GULATI
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 SOUTH ST, SOUTHBRIDGE, MA 01550-4051
(508) 765-9771
(508) 764-9410
Mailing address
79 SAYLES ST, SOUTHBRIDGE, MA 01550-1729
(508) 764-0482
(508) 764-9410
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
Primary
46377
MA
2085R0202X
Diagnostic Radiology Physician
46377
MA
2085U0001X
Diagnostic Ultrasound Physician
46377
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2090244
—
MA
01
—
24783
HARVARD PILGRIM
MA
01
—
316123
TUFTS HEALTH PLAN
MA
01
—
38409
FALLON COMMUNITY HLTH PLA
MA
01
—
J09884
BLUE SHIELD
MA
Enumeration date
03/15/2006
Last updated
09/11/2025
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