Provider Demographics
NPI:1275777617
Name:VARTIKAR, JASMINE V (MD)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:V
Last Name:VARTIKAR
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 1:94 BABCOCK ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5900
Mailing Address - Country:US
Mailing Address - Phone:617-277-1614
Mailing Address - Fax:
Practice Address - Street 1:637 WASHINGTON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4500
Practice Address - Country:US
Practice Address - Phone:617-277-1614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57662208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice