Healthcare Provider Details

I. General information

NPI: 1356398143
Provider Name (Legal Business Name): SHARMILA C MUDGAL M.D.,MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARMILA KUDAV

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE ORTHOPEDICS DRIVE
PEABODY MA
01960
US

IV. Provider business mailing address

18 CHADBOURNE RD
LEXINGTON MA
02421-8211
US

V. Phone/Fax

Practice location:
  • Phone: 978-539-6200
  • Fax: 978-539-6199
Mailing address:
  • Phone: 617-256-9540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number159636
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: