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Provider Information for 1598746620

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

RAVI THIAGARAJAN MD

Gender: MALE

Individual NPI: 1598746620

Calendar   Last Updated:  2019-07-19
  Certification Date: 

Details

Name Value
NPI 1598746620
Enumeration Date 2005-11-07
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address PO BOX 9135 ATT:SHARON SILVA
BROOKLINE, MA 02446-9135
United States

Phone: 800-927-0002 | Fax:
View Map External Link
Primary Practice Address 300 LONGWOOD AVE
BOSTON, MA 02115-5724
United States

Phone: 617-355-6363 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID MA 0147991
MEDICAID RI RT45409
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 2080P0203X - Pediatrics Pediatric Critical Care Medicine MA 209708
No 2080P0202X - Pediatrics Pediatric Cardiology MA 209708
No 208000000X - Pediatrics MA 209708