Provider Demographics
NPI:1841299716
Name:THANGARAJ, KALYANI (MD)
Entity type:Individual
Prefix:DR
First Name:KALYANI
Middle Name:
Last Name:THANGARAJ
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 1:68 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MA
Mailing Address - Zip Code:02330-1128
Mailing Address - Country:US
Mailing Address - Phone:508-747-7813
Mailing Address - Fax:508-747-7256
Practice Address - Street 1:690 CANTON ST
Practice Address - Street 2:SUITE 325
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090
Practice Address - Country:US
Practice Address - Phone:781-407-7713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA46471208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6181198Medicaid
MACA1084Medicare PIN
MA6181198Medicaid
A57086Medicare UPIN
MAJ03619Medicare PIN