1982665089 NPI number — VASUKI RADHAKRISHNAN M.D.

Table of content: VASUKI RADHAKRISHNAN M.D. (NPI 1982665089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982665089 NPI number — VASUKI RADHAKRISHNAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RADHAKRISHNAN
Provider First Name:
VASUKI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982665089
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 WHALON ST
Provider Second Line Business Mailing Address:
SUITE 2A
Provider Business Mailing Address City Name:
FITCHBURG
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01420-7128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-345-1700
Provider Business Mailing Address Fax Number:
978-345-2299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 WHALON ST
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
FITCHBURG
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01420-7128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-345-1700
Provider Business Practice Location Address Fax Number:
978-345-2299
Provider Enumeration Date:
03/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  80627 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 65025 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 080627 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J16245 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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