Healthcare Provider Details

I. General information

NPI: 1609285360
Provider Name (Legal Business Name): OBA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 ELIOT CRESCENT
BROOKLINE MA
02467
US

IV. Provider business mailing address

6 ELIOT CRESCENT
BROOKLINE MA
02467
US

V. Phone/Fax

Practice location:
  • Phone: 773-756-5760
  • Fax: 773-714-1229
Mailing address:
  • Phone: 773-756-5760
  • Fax: 773-714-1229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: HARI SUNDRAM
Title or Position: PRESIDENT
Credential: MD
Phone: 773-756-5760