Healthcare Provider Details

I. General information

NPI: 1710064167
Provider Name (Legal Business Name): RUTH E. SAKAKEENY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RUTH WISEMAN M.D.

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WARREN ST
BRIGHTON MA
02135-3602
US

IV. Provider business mailing address

30 WARREN ST
BRIGHTON MA
02135-3602
US

V. Phone/Fax

Practice location:
  • Phone: 617-779-1500
  • Fax: 617-779-1480
Mailing address:
  • Phone: 617-779-1500
  • Fax: 617-779-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number224109
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: