Organization
NEELAM M. THACKER, M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NEELAM M THACKER M.D. (M.D.)
(781) 396-8100
Entity
Organization
Contact information
Practice address
101 MAIN ST, #210, MEDFORD, MA 02155-4540
(781) 396-8100
(781) 391-9929
Mailing address
101 MAIN ST, #210, MEDFORD, MA 02155-4540
(781) 396-8100
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790832822
TYPE 1 NPI #
MA
Enumeration date
03/29/2013
Last updated
03/29/2013
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