Healthcare Provider Details

I. General information

NPI: 1629363346
Provider Name (Legal Business Name): NEW ENGLAND UROGYNECOLOGY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W CUMMINGS PARK SUITE 2550
WOBURN MA
01801-6372
US

IV. Provider business mailing address

800 W CUMMINGS PARK SUITE 2550
WOBURN MA
01801-6372
US

V. Phone/Fax

Practice location:
  • Phone: 781-460-2120
  • Fax: 781-460-2125
Mailing address:
  • Phone: 781-460-2120
  • Fax: 781-460-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUJATHA RAJAN
Title or Position: OWNER
Credential: M.D.
Phone: 781-460-2120