Healthcare Provider Details

I. General information

NPI: 1407055361
Provider Name (Legal Business Name): NEIL W OLIWA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 SUMNER STREET, M201 GUARDIAN ANESTHESIA INC.
STOUGHTON MA
02072
US

IV. Provider business mailing address

907 SUMNER STREET, M201 GUARDIAN ANESTHESIA INC.
STOUGHTON MA
02072
US

V. Phone/Fax

Practice location:
  • Phone: 781-344-2325
  • Fax: 781-341-8544
Mailing address:
  • Phone: 781-344-2325
  • Fax: 781-341-8544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number231169
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: