Healthcare Provider Details

I. General information

NPI: 1952530685
Provider Name (Legal Business Name): ANA SUJATA MADARIYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST STE 150S
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

5 NEPONSET ST FL STREET2
WORCESTER MA
01606-2714
US

V. Phone/Fax

Practice location:
  • Phone: 508-368-3110
  • Fax: 508-368-3113
Mailing address:
  • Phone: 508-949-6874
  • Fax: 508-949-6739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number60344560
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number62860
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number269093
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: