Healthcare Provider Details

I. General information

NPI: 1619455318
Provider Name (Legal Business Name): PRATIBHA SURATHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SOUTH ST
SOUTHBRIDGE MA
01550-4051
US

IV. Provider business mailing address

281 LINCOLN ST
WORCESTER MA
01605-2138
US

V. Phone/Fax

Practice location:
  • Phone: 508-764-2515
  • Fax: 508-765-2457
Mailing address:
  • Phone: 508-334-8105
  • Fax: 508-334-8105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number1027385
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: