Provider Demographics
NPI:1164470365
Name:WAHI, MADHU A (MD)
Entity Type:Individual
Prefix:
First Name:MADHU
Middle Name:A
Last Name:WAHI
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 1:50 STANIFORD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2542
Mailing Address - Country:US
Mailing Address - Phone:617-726-4626
Mailing Address - Fax:
Practice Address - Street 1:50 STANIFORD ST STE 300
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2542
Practice Address - Country:US
Practice Address - Phone:617-726-4626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209163207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2003431Medicaid
MA209163OtherTUFTS
MAJ25870OtherBLUE CROSS
MA695189OtherHARVARD PILGRIM
MA2003431Medicaid
MAA35196Medicare PIN
MA209163OtherTUFTS