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General NPI Number Information
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NPI Number | 1356976195
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Entity Type | Organization
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Legal Business Name | ROOTHEALTHMD
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Dates
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Enumeration Date | 03/11/2020
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 463 WORCESTER RD STE 103
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City | FRAMINGHAM
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State | MA
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Zip | 01701-5354
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Country | US
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Telephone | 509-239-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 463 WORCESTER RD STE 103
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City | FRAMINGHAM
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State | MA
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Zip | 01701-5354
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Country | US
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Telephone | 781-696-4092
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. SAILAJA KANDRA REDDY
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Credential | MD
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Telephone | 781-696-4092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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