Healthcare Provider Details

I. General information

NPI: 1457736753
Provider Name (Legal Business Name): SREELAKSHMI PANGINIKKOD M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST
BOSTON MA
02111-1552
US

IV. Provider business mailing address

55 LAKE AVENUE NORTH RHEUMATOLOGY
WORCESTER MA
01655
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-5224
  • Fax: 508-334-5654
Mailing address:
  • Phone: 508-856-6246
  • Fax: 508-856-4770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number282815
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: