Healthcare Provider Details

I. General information

NPI: 1235238015
Provider Name (Legal Business Name): SUMITA GOKHALE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CAMBRIDGE CTR, ROOM 449 WHITEHEAD INSTITUTE-BIOMEDICAL RESEARCH
CAMBRIDGE MA
02142
US

IV. Provider business mailing address

2234 LEXINGTON RIDGE DR
LEXINGTON MA
02421-8306
US

V. Phone/Fax

Practice location:
  • Phone: 617-258-5189
  • Fax:
Mailing address:
  • Phone: 617-258-5189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberMD12289
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD12289
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: