Healthcare Provider Details

I. General information

NPI: 1063542660
Provider Name (Legal Business Name): RANJANA RAJEEV MUNDHE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 ARSENAL ST HARVARD VANGUARD MEDICAL ASSOCIATES
WATERTOWN MA
02472
US

IV. Provider business mailing address

485 ARSENAL ST HARVARD VANGUARD MEDICAL ASSOCIATES
WATERTOWN MA
02472
US

V. Phone/Fax

Practice location:
  • Phone: 617-972-5200
  • Fax: 617-972-5276
Mailing address:
  • Phone: 617-972-5200
  • Fax: 617-972-5276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50506
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: