Healthcare Provider Details

I. General information

NPI: 1548822737
Provider Name (Legal Business Name): SHRUTI SHEKHAR GOTHOSKAR MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 12/03/2022
Certification Date: 07/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 MAIN ST
SPRINGFIELD MA
01103-2114
US

IV. Provider business mailing address

1049 MAIN ST
SPRINGFIELD MA
01103-2114
US

V. Phone/Fax

Practice location:
  • Phone: 413-739-1100
  • Fax:
Mailing address:
  • Phone: 413-739-1100
  • Fax: 413-735-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMTL005255
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number294735
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: