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General NPI Number Information
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NPI Number | 1174290951
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Entity Type | Individual
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Provider Name | AMRUTHA DENDULURI MBBS, MPH
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Gender | Female
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Dates
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Enumeration Date | 08/27/2021
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 637 WASHINGTON STREET
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City | DORCHESTER
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State | MA
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Zip | 02124-3510
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Country | US
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Telephone | 617-825-9660
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Fax |
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Provider Business Mailing Address
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Address Line | 960 MASSACHUSETTS AVE STE 2
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City | BOSTON
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State | MA
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Zip | 02118-2690
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Country | US
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Telephone | 617-414-5404
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1020881
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License Number State | MA
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