Provider Demographics
NPI:1649333857
Name:VERMA, TILAK K (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:TILAK
Middle Name:K
Last Name:VERMA
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40 DRYDEN AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5753
Mailing Address - Country:US
Mailing Address - Phone:401-658-2539
Mailing Address - Fax:401-658-0563
Practice Address - Street 1:175 NATE WHIPPLE HWY
Practice Address - Street 2:SUITE 108
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-1416
Practice Address - Country:US
Practice Address - Phone:401-658-2539
Practice Address - Fax:401-658-0563
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI5875207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RID87307Medicare UPIN
RI007000694Medicare ID - Type Unspecified