Provider Demographics
NPI:1154302818
Name:THADHANI, VALERIE S (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:S
Last Name:THADHANI
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 1:11 BYRON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-3401
Mailing Address - Country:US
Mailing Address - Phone:617-953-4332
Mailing Address - Fax:
Practice Address - Street 1:11 BYRON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-3401
Practice Address - Country:US
Practice Address - Phone:617-953-4332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ31959OtherBCBS MA
MA3151476Medicaid
MA151149OtherTUFTS HEALTH PLAN
MA151149OtherTUFTS HEALTH PLAN
MAJ31959OtherBCBS MA