Provider Demographics
NPI:1043257637
Name:SODERBERG, RUTH M (NP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:M
Last Name:SODERBERG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 BAY ST
Mailing Address - Street 2:STE 103
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-1086
Mailing Address - Country:US
Mailing Address - Phone:508-880-7858
Mailing Address - Fax:508-822-5972
Practice Address - Street 1:2007 BAY ST
Practice Address - Street 2:STE 103
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-1086
Practice Address - Country:US
Practice Address - Phone:508-880-7858
Practice Address - Fax:508-822-5972
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA124419NP208000000X
MA124419363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0318116Medicaid
MAS94626Medicare UPIN