Healthcare Provider Details

I. General information

NPI: 1780810572
Provider Name (Legal Business Name): PRANAV OZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 KNEELAND ST FL 1
BOSTON MA
02111-1901
US

IV. Provider business mailing address

1 NASSAU ST UNIT 1906
BOSTON MA
02111-1587
US

V. Phone/Fax

Practice location:
  • Phone: 617-804-6767
  • Fax: 877-726-8492
Mailing address:
  • Phone: 617-804-6767
  • Fax: 877-726-8492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number240860
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: