Provider Demographics
NPI:1528040615
Name:MOOTHA, VAMSI KRISHNA (MD)
Entity Type:Individual
Prefix:DR
First Name:VAMSI
Middle Name:KRISHNA
Last Name:MOOTHA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:15 VALENTINE ST
Mailing Address - Street 2:UNIT #15
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4032
Mailing Address - Country:US
Mailing Address - Phone:617-945-9445
Mailing Address - Fax:617-726-5735
Practice Address - Street 1:185 CAMBRIDGE ST
Practice Address - Street 2:CPZN-5806
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2790
Practice Address - Country:US
Practice Address - Phone:617-643-3096
Practice Address - Fax:617-726-5735
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA210078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine