Provider Demographics
NPI:1447240858
Name:THATAI, LATA CHANDI (MD)
Entity Type:Individual
Prefix:DR
First Name:LATA
Middle Name:CHANDI
Last Name:THATAI
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 1:41 MALL RD
Mailing Address - Street 2:LAHEY CLINIC
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8400
Mailing Address - Fax:781-744-5293
Practice Address - Street 1:41 MALL RD
Practice Address - Street 2:LAHEY CLINIC
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-8400
Practice Address - Fax:781-744-5293
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14308207RH0003X
MA238463207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30208399Medicaid
MA110081808AMedicaid
MA000940601Medicare PIN
H93741Medicare UPIN
MA000940602Medicare PIN
NH000940858Medicare PIN