Healthcare Provider Details

I. General information

NPI: 1780613620
Provider Name (Legal Business Name): SVETLANA DROZNIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 NORTH RD
BEDFORD MA
01730-1024
US

IV. Provider business mailing address

218 NORTH RD
BEDFORD MA
01730-1024
US

V. Phone/Fax

Practice location:
  • Phone: 781-687-2433
  • Fax: 781-687-2018
Mailing address:
  • Phone: 781-687-2433
  • Fax: 781-687-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number48291
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: