Provider Demographics
NPI:1225028483
Name:HEDLEY-WHYTE, E TESSA (MD MBBS)
Entity Type:Individual
Prefix:DR
First Name:E
Middle Name:TESSA
Last Name:HEDLEY-WHYTE
Suffix:
Gender:F
Credentials:MD MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:WRN 325
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-5154
Practice Address - Fax:617-724-1813
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27314207ZN0500X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2091887Medicaid
MAJ01191OtherBCBS MA
MA027314OtherTUFTS HEALTH PLAN
MAJ01191Medicare ID - Type Unspecified
MA2091887Medicaid