Provider Demographics
NPI:1255385266
Name:RAMASWAMI, SHENBAGAVALLI (MD)
Entity type:Individual
Prefix:DR
First Name:SHENBAGAVALLI
Middle Name:
Last Name:RAMASWAMI
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 1:830 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1168
Mailing Address - Country:US
Mailing Address - Phone:781-585-9522
Mailing Address - Fax:781-585-9544
Practice Address - Street 1:830 OAK ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1168
Practice Address - Country:US
Practice Address - Phone:781-585-9522
Practice Address - Fax:781-585-9544
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51635207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA512961OtherAETNA
MAJ05614OtherBLUE CROSS BLUE SHIELD
MA13148OtherHARVARDPILGRIM HEALTHCARE
MA0011347OtherNEIGHBORHOOD HEALTH PLAN
MA3007421Medicaid
MA7111286OtherCIGNA
MAMA0013080OtherTRICARE
MA051635OtherTUFTS HEALTH PLAN
MA31209OtherBOSTONMEDICAL HEALTHNET
MAJ05614OtherBLUE CROSS BLUE SHIELD