Individual
DR. RONALD WAYNE TAKVORIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, YAW 7B HEMATOLOGY ONCOLOGY, BOSTON, MA 02114-2621
(617) 724-1134
(617) 724-1137
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
41347
MA
207RH0003X
Hematology & Oncology Physician
41347
MA
207RX0202X
Medical Oncology Physician
Primary
41347
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0115363
—
MA
01
—
729753
TUFTS HEALTH PLAN
MA
01
—
E05323
BCBS MA
MA
Enumeration date
11/11/2005
Last updated
04/24/2018
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