Provider Demographics
NPI:1982665089
Name:RADHAKRISHNAN, VASUKI (MD)
Entity Type:Individual
Prefix:
First Name:VASUKI
Middle Name:
Last Name:RADHAKRISHNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WHALON ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-7128
Mailing Address - Country:US
Mailing Address - Phone:978-345-1700
Mailing Address - Fax:978-345-2299
Practice Address - Street 1:104 WHALON ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-7128
Practice Address - Country:US
Practice Address - Phone:978-345-1700
Practice Address - Fax:978-345-2299
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA80627207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA65025OtherHARVARD PILGRIM
MA080627OtherTUFTS
MAJ16245OtherBLUE CROSS BLUE SHIELD
MA080627OtherTUFTS
MAA20429Medicare PIN