Individual
VASANT MUKUND THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
101 MAIN ST, #210, MEDFORD, MA 02155-4530
(781) 396-8100
(781) 391-9929
Mailing address
3 PINEHURST ROAD, BELMONT, MA 02478-1517
(617) 484-3668
(781) 391-9929
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
39145
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0129917
—
MA
Enumeration date
02/02/2007
Last updated
12/02/2011
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