Healthcare Provider Details

I. General information

NPI: 1902888589
Provider Name (Legal Business Name): AARON DAVID SODICKSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS STREET RADIOLOGY BRIGHAM & WOMENS HOSPITAL
BOSTON MA
02115
US

IV. Provider business mailing address

75 FRANCIS STREET RADIOLOGY BRIGHAM & WOMENS HOSPITAL
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-6506
  • Fax: 617-732-6336
Mailing address:
  • Phone: 617-732-6506
  • Fax: 617-732-6336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number210534
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: