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Provider Information for 1952409005

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

DR. WANDA PHIPATANAKUL MD, MS

Gender: FEMALE

Individual NPI: 1952409005

Calendar   Last Updated:  2007-07-08
  Certification Date: 

Details

Name Value
NPI 1952409005
Enumeration Date 2006-09-20
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 30 OVERLOOK RD
HOPKINTON, MA 01748-3220
United States

Phone: 508-497-2345 | Fax:
View Map External Link
Primary Practice Address 300 LONGWOOD AVE
BOSTON, MA 02115-5724
United States

Phone: 617-355-6117 | Fax: 617-730-0310
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 3207980
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207K00000X - Allergy & Immunology MA 204416