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General NPI Number Information
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NPI Number | 1740193432
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Entity Type | Individual
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Provider Name | VAFA MAMMADOVA
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Gender | Female
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Dates
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Enumeration Date | 09/24/2026
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Last Update Date | 09/24/2026
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Provider Practice Location Address
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Address Line | 55 LAKE AVE N
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City | WORCESTER
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State | MA
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Zip | 01655-0002
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Country | US
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Telephone | 508-334-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 4121 HOMESTEAD BLVD
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City | WESTBOROUGH
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State | MA
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Zip | 01581-1066
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Country | US
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Telephone |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 3021728
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License Number State | MA
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