Individual
RAVI THIAGARAJAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6363
Mailing address
PO BOX 9135, ATT:SHARON SILVA, BROOKLINE, MA 02446-9135
(800) 927-0002
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
209708
MA
2080P0202X
Pediatric Cardiology Physician
209708
MA
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
209708
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0147991
—
MA
05
—
RT45409
—
RI
Enumeration date
11/07/2005
Last updated
07/19/2019
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