Provider Demographics
NPI:1609856517
Name:PATALAS, EVA D (MD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:D
Last Name:PATALAS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:RPH
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:1493 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1047
Practice Address - Country:US
Practice Address - Phone:617-665-1220
Practice Address - Fax:617-665-1205
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA153678207ZF0201X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3189643Medicaid
MAJ19696OtherBCBS MA
MA153678OtherTUFTS HEALTH PLAN
MAA29017Medicare ID - Type Unspecified
MA3189643Medicaid