Individual
DR. RAVI ISHWAR THADHANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
55 FRUIT ST, RENAL ASSOCIATES GRB 1003, BOSTON, MA 02114-2621
(617) 724-1207
(617) 726-2340
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
81439
MA
207RN0300X
Nephrology Physician
Primary
81439
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3149820
—
MA
01
—
735290
TUFTS HEALTH PLAN
MA
01
—
J16479
BCBS MA
MA
Enumeration date
11/08/2005
Last updated
03/17/2020
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