Provider Demographics
NPI:1629106679
Name:DHANABALAN, UMA (MD, MPH, FAAFP)
Entity type:Individual
Prefix:DR
First Name:UMA
Middle Name:
Last Name:DHANABALAN
Suffix:
Gender:F
Credentials:MD, MPH, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 CONCORD AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1053
Mailing Address - Country:US
Mailing Address - Phone:508-444-2324
Mailing Address - Fax:508-340-4930
Practice Address - Street 1:777 CONCORD AVE STE 106
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1053
Practice Address - Country:US
Practice Address - Phone:508-444-2324
Practice Address - Fax:508-340-4930
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157551207Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAZ006251Medicaid
MAAA65606OtherHARVARD PILGRIM
MAJ26406OtherBLUE CROSS BLUE SHIELD
MA1319219OtherAETNA
MAZ006251Medicaid
MAH84308Medicare UPIN