Provider Demographics
NPI:1578937587
Name:VARDEH, HILDE (MD)
Entity Type:Individual
Prefix:MRS
First Name:HILDE
Middle Name:
Last Name:VARDEH
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 1:300 BROOKLINE AVE
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5403
Mailing Address - Country:US
Mailing Address - Phone:617-667-4344
Mailing Address - Fax:617-667-7120
Practice Address - Street 1:300 BROOKLINE AVE
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5403
Practice Address - Country:US
Practice Address - Phone:617-667-4344
Practice Address - Fax:617-667-7120
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA256158390200000X
RIMD16658207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program