Healthcare Provider Details

I. General information

NPI: 1386850428
Provider Name (Legal Business Name): SAMANTHA R MEKRUT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 GREAT ROCK RD
SHERBORN MA
01770-1608
US

IV. Provider business mailing address

30 GREAT ROCK RD
SHERBORN MA
01770-1608
US

V. Phone/Fax

Practice location:
  • Phone: 508-466-5939
  • Fax: 617-690-5963
Mailing address:
  • Phone: 508-466-5939
  • Fax: 617-690-5963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number229051
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD443428
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number238756
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: