Healthcare Provider Details

I. General information

NPI: 1063662112
Provider Name (Legal Business Name): UJALA FAWAD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PROVIDENCE HWY STE 22B
NORWOOD MA
02062-4649
US

IV. Provider business mailing address

1500 PROVIDENCE HWY STE 22B
NORWOOD MA
02062-4649
US

V. Phone/Fax

Practice location:
  • Phone: 508-206-8578
  • Fax:
Mailing address:
  • Phone: 508-206-8578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberTPME303
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD14383
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number250484
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: