Healthcare Provider Details

I. General information

NPI: 1356432603
Provider Name (Legal Business Name): SUBHASH C. GULATI, MD , FACS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 LINCOLN ST SUITE 204
WORCESTER MA
01605-3643
US

IV. Provider business mailing address

291 LINCOLN ST SUITE 204
WORCESTER MA
01605-3643
US

V. Phone/Fax

Practice location:
  • Phone: 508-755-0770
  • Fax:
Mailing address:
  • Phone: 508-755-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number48512
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number48512
License Number StateMA

VIII. Authorized Official

Name: SUBHASH C. GULATI
Title or Position: PRESIDENT
Credential: MD
Phone: 508-755-0770