Provider Demographics
NPI:1730144981
Name:DHADLY, MANDEEP S (MD)
Entity Type:Individual
Prefix:
First Name:MANDEEP
Middle Name:S
Last Name:DHADLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:133 BROOKLINE AVE
Mailing Address - Street 2:CARDIOLOGY DEPT
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3904
Mailing Address - Country:US
Mailing Address - Phone:617-421-6050
Mailing Address - Fax:617-421-6083
Practice Address - Street 1:133 BROOKLINE AVE
Practice Address - Street 2:CARDIOLOGY DEPT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3904
Practice Address - Country:US
Practice Address - Phone:617-421-6050
Practice Address - Fax:617-421-6083
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA81869207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3155463Medicaid
MAG26248Medicare UPIN
MASX0831Medicare PIN