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General NPI Number Information
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NPI Number | 1194077909
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Entity Type | Organization
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Legal Business Name | ROSE ANN BERWALD, M.D.
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Dates
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Enumeration Date | 10/04/2012
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Last Update Date | 10/04/2012
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Provider Practice Location Address
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Address Line | 966 PARK ST STE B2
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City | STOUGHTON
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State | MA
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Zip | 02072-3650
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Country | US
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Telephone | 781-344-7673
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Fax | 781-344-5955
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Provider Business Mailing Address
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Address Line | 966 PARK ST STE B2
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City | STOUGHTON
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State | MA
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Zip | 02072-3650
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Country | US
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Telephone | 781-344-7673
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Fax | 781-344-5955
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ROSE ANN BERWALD
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Credential | MD
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Telephone | 781-344-7673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 70519
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License Number State | MA
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