Healthcare Provider Details

I. General information

NPI: 1194163675
Provider Name (Legal Business Name): SHWETA RAHUL YEMUL GOLHAR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHWETA VISHWANATH YEMUL M.D

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215-5400
US

IV. Provider business mailing address

330 BROOKLINE AVE
BOSTON MA
02215-5491
US

V. Phone/Fax

Practice location:
  • Phone: 207-281-2014
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number286856
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: