Provider Demographics
NPI:1972550440
Name:DINH, THANH L (DPM)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:L
Last Name:DINH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 PILGRIM RD
Mailing Address - Street 2:DIVISION OF PODIATRY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5324
Mailing Address - Country:US
Mailing Address - Phone:617-632-8428
Mailing Address - Fax:617-632-7090
Practice Address - Street 1:185 PILGRIM RD
Practice Address - Street 2:DIVISION OF PODIATRY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5324
Practice Address - Country:US
Practice Address - Phone:617-632-8428
Practice Address - Fax:617-632-7090
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2153213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0326551Medicaid
MAY75089Medicare ID - Type Unspecified
MA0326551Medicaid