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NPI Code Detail

MEDICARE: DR. SUVRANU GANGULI M.D.

MEDICARE: DR. SUVRANU GANGULI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0204XVascular & Interventional Radiology Physician230920MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811023492
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUVRANU GANGULI M.D.
Provider Business Mailing Address
First Line : 960 MASSACHUSETTS AVENUE
Second Line : FL 2
City : BOSTON
State : MA
Zip : 02118
Country : US
Telephone Number : 617-414-5405
Fax Number : 617-414-6031
Provider Business Practice Location Address
First Line : 840 HARRISON AVE
Second Line :
City : BOSTON
State : MA
Zip : 02118-2905
Country : US
Telephone Number : 617-638-6610
Fax Number : 617-638-6616
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2007
Last Update Date : 01/12/2026

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