Healthcare Provider Details

I. General information

NPI: 1528150976
Provider Name (Legal Business Name): ANUPMA JATI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY
WEST ROXBURY MA
02132-4927
US

IV. Provider business mailing address

180 SOUTH ST
CHESTNUT HILL MA
02467-3666
US

V. Phone/Fax

Practice location:
  • Phone: 508-583-4500
  • Fax:
Mailing address:
  • Phone: 781-708-3823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number226416
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number226416
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number226416
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: