Healthcare Provider Details

I. General information

NPI: 1396724449
Provider Name (Legal Business Name): BERRYZAD EZZAT RAMADAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 10/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 LITTLETON RD
WESTFORD MA
01886-3408
US

IV. Provider business mailing address

8 NEW FLETCHER ST
CHELMSFORD MA
01824-2816
US

V. Phone/Fax

Practice location:
  • Phone: 978-746-6382
  • Fax:
Mailing address:
  • Phone: 978-250-1097
  • Fax: 978-453-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number217120
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: