Healthcare Provider Details

I. General information

NPI: 1407774292
Provider Name (Legal Business Name): GOVARDHANA PUNDROTHU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 GREAT RD
ACTON MA
01720-5643
US

IV. Provider business mailing address

188 SOUTH RD
PEPPERELL MA
01463-1208
US

V. Phone/Fax

Practice location:
  • Phone: 351-230-0457
  • Fax:
Mailing address:
  • Phone: 214-403-7526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: