Provider Demographics
NPI:1780091686
Name:ROYCHOWDHURY, SURAJA MENON (PHD, LICAC, MAOM)
Entity type:Individual
Prefix:DR
First Name:SURAJA
Middle Name:MENON
Last Name:ROYCHOWDHURY
Suffix:
Gender:F
Credentials:PHD, LICAC, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 LACONIA ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-2229
Mailing Address - Country:US
Mailing Address - Phone:610-731-5030
Mailing Address - Fax:
Practice Address - Street 1:79 LACONIA ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-2229
Practice Address - Country:US
Practice Address - Phone:610-731-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-13
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA261174171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program