Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 48697 | MA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 48697 | MA |
N | 2081P2900X | Pain Medicine | 48697 | MA |
NPI | 1386704864 |
---|---|
Provider Name | Dr. Saroj Bharat Dave |
First Address | Wayland, MA 01778-4438 |
Second Address | Stoughton, MA 02072-1829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0193186 | (05) | MA |
097076 | (02) | MA |