Provider Demographics
NPI:1063662112
Name:FAWAD, UJALA (MD)
Entity Type:Individual
Prefix:DR
First Name:UJALA
Middle Name:
Last Name:FAWAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 PROVIDENCE HWY STE 22B
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-4649
Mailing Address - Country:US
Mailing Address - Phone:508-206-8578
Mailing Address - Fax:
Practice Address - Street 1:1500 PROVIDENCE HWY STE 22B
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4649
Practice Address - Country:US
Practice Address - Phone:508-206-8578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPME3032084P0800X
RIMD143832084P0800X
MA2504842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry