Healthcare Provider Details

I. General information

NPI: 1386623247
Provider Name (Legal Business Name): SHARMILA DORBALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST RADIOLOGY BRIGHAM & WOMANS HOSPITAL
BOSTON MA
02115
US

IV. Provider business mailing address

75 FRANCIS ST RADIOLOGY BRIGHAM & WOMANS HOSPITAL
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-6269
  • Fax: 617-525-7333
Mailing address:
  • Phone: 617-732-6269
  • Fax: 617-525-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number208653
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number208653
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number208653
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: