Provider Demographics
NPI:1891718250
Name:MURALI, MANDAKOLATHUR R (MD)
Entity Type:Individual
Prefix:DR
First Name:MANDAKOLATHUR
Middle Name:R
Last Name:MURALI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-3850
Mailing Address - Fax:617-726-3847
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:COX 201
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-3850
Practice Address - Fax:617-726-3847
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA213978207K00000X, 207KI0005X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA213978OtherTUFTS HEALTH PLAN
MA0169366Medicaid
MAJ24730OtherBCBS MA
MAJ24730OtherBCBS MA
MA0169366Medicaid