Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | LIMITED | MA |
NPI | 1003495219 |
---|---|
Provider Name | Madhuri Preeti Rao |
First Address | Malden, MA 02148-6701 |
Second Address | Malden, MA 02148-6701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2021 |
Last Update Date | 05/04/2021 |