Healthcare Provider Details

I. General information

NPI: 1609077866
Provider Name (Legal Business Name): NUPUR SAXENA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 HARRISON AVE PRESTON FIFTH FLOOR
BOSTON MA
02118-2309
US

IV. Provider business mailing address

1 NASSAU ST APT 406
BOSTON MA
02111-1541
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-0044
  • Fax:
Mailing address:
  • Phone: 330-328-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number277067
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: