Provider Demographics
NPI:1891854170
Name:TESS, ANJALA VAISHAMPAYAN (MD)
Entity Type:Individual
Prefix:
First Name:ANJALA
Middle Name:VAISHAMPAYAN
Last Name:TESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANJALA
Other - Middle Name:RAY
Other - Last Name:VAISHAMPAYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:330 BROOKLINE AVENUE
Mailing Address - Street 2:BIDMC, W/PBS-2,
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-754-4677
Mailing Address - Fax:617-632-0215
Practice Address - Street 1:330 BROOKLINE AVENUE
Practice Address - Street 2:W/PBS-2,
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-754-4677
Practice Address - Fax:617-632-0215
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205465208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH33962Medicare UPIN