Healthcare Provider Details

I. General information

NPI: 1932339025
Provider Name (Legal Business Name): SWAPNA LAKSHMI PUTTA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FOGG ROAD BWH DEPARTMENT OF NEUROLOGY, EMERSON 150
SOUTH WEUMOUTH MA
02190
US

IV. Provider business mailing address

55 FOGG ROAD BWH DEPARTMENT OF NEUROLOGY, EMERSON 150
SOUTH WEUMOUTH MA
02190
US

V. Phone/Fax

Practice location:
  • Phone: 781-624-8197
  • Fax: 781-624-6735
Mailing address:
  • Phone: 781-624-8197
  • Fax: 781-624-6735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number254663
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number254663
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: