Provider Demographics
NPI:1740600295
Name:THEVA, DIDI PATHAK (MD)
Entity Type:Individual
Prefix:
First Name:DIDI
Middle Name:PATHAK
Last Name:THEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 MILL RD STE 180
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5255
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:1601 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02724-2107
Practice Address - Country:US
Practice Address - Phone:508-678-0004
Practice Address - Fax:508-678-6970
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2020-10-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA278505208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology