Provider Demographics
NPI:1184635633
Name:THAKORE-JAMES, MANISHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MANISHA
Middle Name:
Last Name:THAKORE-JAMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:150 S HUNTINGTON AVE
Mailing Address - Street 2:NEUROLOGY (127)
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4817
Mailing Address - Country:US
Mailing Address - Phone:617-232-9500
Mailing Address - Fax:
Practice Address - Street 1:150 SOUTH HUNTINGTON AVENUE
Practice Address - Street 2:BOSTON VA MEDICAL CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:01230
Practice Address - Country:US
Practice Address - Phone:617-232-9500
Practice Address - Fax:857-364-4454
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA811842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAVAD000Medicare UPIN