Individual
DR. MANISHA THAKURIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
221 LONGWOOD AVE, BOSTON, MA 02115-5804
(617) 732-4918
Mailing address
375 BOYLSTON ST, BROOKLINE, MA 02445-6007
(857) 307-0867
Taxonomy
Speciality
Code
Description
License number
State
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
Primary
245821
MA
390200000X
Student in an Organized Health Care Education/Training Program
4301088143
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110087251A
—
MA
Enumeration date
04/06/2007
Last updated
11/21/2019
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