Healthcare Provider Details

I. General information

NPI: 1942464524
Provider Name (Legal Business Name): SUCHETA JAYANTILAL DOSHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY VA BOSTON HEALTHCARE SYSTEM
WEST ROXBURY MA
02132-4927
US

IV. Provider business mailing address

150 S HUNTINGTON AVE
BOSTON MA
02130-4817
US

V. Phone/Fax

Practice location:
  • Phone: 857-364-5544
  • Fax:
Mailing address:
  • Phone: 857-364-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number224135
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number224135
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number224135
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: