Basic Information
| Provider Information | |||||||||
| NPI: | 1780810572 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OZA | ||||||||
| FirstName: | PRANAV | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 362 N BEDFORD ST | ||||||||
| Address2: | |||||||||
| City: | EAST BRIDGEWATER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023331148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085657600 | ||||||||
| FaxNumber: | 5085657605 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 BRISTOL DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | SOUTH EASTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023751199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085657600 | ||||||||
| FaxNumber: | 5085657605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2009 | ||||||||
| LastUpdateDate: | 10/25/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 240860 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | S400344670 | 01 | MA | MEDICARE PTAN | OTHER |