Provider Demographics
NPI:1477609725
Name:THARAYIL, MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:THARAYIL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:133 BROOKLINE AVE
Mailing Address - Street 2:INTERNAL MEDICINE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3904
Mailing Address - Country:US
Mailing Address - Phone:617-421-5804
Mailing Address - Fax:617-421-8865
Practice Address - Street 1:133 BROOKLINE AVE
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3904
Practice Address - Country:US
Practice Address - Phone:617-421-5804
Practice Address - Fax:617-421-8865
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2011-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA221729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2148471Medicaid
MA000532101Medicare PIN