Healthcare Provider Details

I. General information

NPI: 1154065241
Provider Name (Legal Business Name): SARA R RENDELL MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 FRANCIS ST
BOSTON MA
02115-6105
US

IV. Provider business mailing address

55 FRUIT STREET BUL-1-130
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-8881
  • Fax:
Mailing address:
  • Phone:
  • Fax: 215-615-3995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number3015675
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: