Provider Demographics
NPI:1467933309
Name:RASSAMEEHIRUN, CHAVISA
Entity Type:Individual
Prefix:
First Name:CHAVISA
Middle Name:
Last Name:RASSAMEEHIRUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BROOKLINE AVE APT 4B
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5404
Mailing Address - Country:US
Mailing Address - Phone:617-784-2818
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE UNIT
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-8087
Practice Address - Fax:617-730-1909
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2746092080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty