Provider Demographics
NPI:1891755443
Name:NORI, SARITA (MD)
Entity Type:Individual
Prefix:
First Name:SARITA
Middle Name:
Last Name:NORI
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 1:40 HOLLAND ST
Mailing Address - Street 2:HARVARD VANGUARD MED ASSOC, 2ND FLOOR
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144
Mailing Address - Country:US
Mailing Address - Phone:617-629-6250
Mailing Address - Fax:617-629-6108
Practice Address - Street 1:40 HOLLAND ST
Practice Address - Street 2:HARVARD VANGUARD MED ASSOC, 2ND FLOOR
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144
Practice Address - Country:US
Practice Address - Phone:617-629-6250
Practice Address - Fax:617-629-6108
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209453207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2108593Medicaid
MAA39238Medicare PIN