Provider Demographics
NPI:1386700706
Name:SHENBAGAVALI RAMASWAMI, MD
Entity type:Organization
Organization Name:SHENBAGAVALI RAMASWAMI, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHENBAGAVALLI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMASWAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-585-9522
Mailing Address - Street 1:830 OAK ST
Mailing Address - Street 2:STE 102W
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1168
Mailing Address - Country:US
Mailing Address - Phone:781-585-9522
Mailing Address - Fax:781-585-9544
Practice Address - Street 1:830 OAK ST
Practice Address - Street 2:STE 102W
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1168
Practice Address - Country:US
Practice Address - Phone:781-585-9522
Practice Address - Fax:781-585-9544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51635207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA051635OtherTUFTS
MA13148OtherHARVARD PILGRIM HEALTHCAR
MA3007421Medicaid
MAJ05614OtherBLUE CROSS BLUE SHIELD
MAJ05614Medicare ID - Type Unspecified
MA3007421Medicaid