Healthcare Provider Details

I. General information

NPI: 1669448049
Provider Name (Legal Business Name): SOROYA M RAHAMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 OBERY ST
PLYMOUTH MA
02360-2229
US

IV. Provider business mailing address

47 OBERY ST
PLYMOUTH MA
02360-2229
US

V. Phone/Fax

Practice location:
  • Phone: 508-747-1560
  • Fax: 508-747-5155
Mailing address:
  • Phone: 508-747-1560
  • Fax: 508-747-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME148356
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number75477
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: