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General NPI Number Information
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NPI Number | 1053488098
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Entity Type | Individual
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Provider Name | RAVINDER S SOODAN MD
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Gender | Male
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 72 SHARP ST SUITE A10
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City | HINGHAM
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State | MA
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Zip | 02043
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Country | US
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Telephone | 781-331-2010
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Fax | 781-340-9915
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Provider Business Mailing Address
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Address Line | PO BOX 295
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City | S WEYMOUTH
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State | MA
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Zip | 02190
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Country | US
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Telephone | 781-331-2010
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Fax | 781-340-9915
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 59327
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License Number State | MA
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