Healthcare Provider Details

I. General information

NPI: 1043257637
Provider Name (Legal Business Name): RUTH M SODERBERG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 BAY ST STE 103
TAUNTON MA
02780-1086
US

IV. Provider business mailing address

2007 BAY ST STE 103
TAUNTON MA
02780-1086
US

V. Phone/Fax

Practice location:
  • Phone: 508-880-7858
  • Fax: 508-822-5972
Mailing address:
  • Phone: 508-880-7858
  • Fax: 508-822-5972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number124419NP
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number124419
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: