Healthcare Provider Details

I. General information

NPI: 1346712759
Provider Name (Legal Business Name): NEW ENGLAND UROGYNECOLOGY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2018
Last Update Date: 02/23/2020
Certification Date: 02/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W CUMMINGS PARK STE 2550
WOBURN MA
01801-6389
US

IV. Provider business mailing address

800 W CUMMINGS PARK STE 2550
WOBURN MA
01801-6389
US

V. Phone/Fax

Practice location:
  • Phone: 781-460-2120
  • Fax:
Mailing address:
  • Phone: 781-460-2120
  • Fax: 781-460-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUJATHA S. RAJAN
Title or Position: PRESIDENT
Credential: MD
Phone: 781-460-2120