Individual
DR. MANDAKOLATHUR R MURALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT STREET, COX 201, BOSTON, MA 02114-3117
(617) 726-3850
(617) 726-3847
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 726-3850
(617) 726-3847
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
213978
MA
207KI0005X
Clinical & Laboratory Immunology (Allergy & Immunology) Physician
213978
MA
207R00000X
Internal Medicine Physician
213978
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0169366
—
MA
01
—
213978
TUFTS HEALTH PLAN
MA
01
—
J24730
BCBS MA
MA
Enumeration date
07/26/2006
Last updated
05/03/2016
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