Provider Demographics
NPI:1649436940
Name:VIRKUD, YAMINI (MD)
Entity type:Individual
Prefix:
First Name:YAMINI
Middle Name:
Last Name:VIRKUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 CAMBRIDGE ST
Mailing Address - Street 2:SUITE 530
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:275 CAMBRIDGE ST
Practice Address - Street 2:SUITE 530
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3108
Practice Address - Country:US
Practice Address - Phone:617-643-6834
Practice Address - Fax:617-724-2803
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008018211208000000X
MABOARD ELIGIBLE207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics