Provider Demographics
NPI:1700885639
Name:POULOSE, SINI (DO)
Entity Type:Individual
Prefix:MRS
First Name:SINI
Middle Name:
Last Name:POULOSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SINI
Other - Middle Name:
Other - Last Name:NINAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:LAHEY HEALTH PRIMARY CARE, LYNNFIELD
Mailing Address - Street 2:6 KIMBALL LANE, SUITE 120
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-2667
Mailing Address - Country:US
Mailing Address - Phone:781-213-4040
Mailing Address - Fax:
Practice Address - Street 1:LAHEY HEALTH PRIMARY CARE, LYNNFIELD
Practice Address - Street 2:6 KIMBALL LANE, SUITE 120
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-2667
Practice Address - Country:US
Practice Address - Phone:781-213-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA234825207Q00000X
TXL6130207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170320901Medicaid
H88020Medicare UPIN
8C9874Medicare ID - Type Unspecified