Individual
DEEPAK THATAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
103 GARLAND ST, MEDICAL SPECIALTIES, EVERETT, MA 02149-5066
(617) 843-0752
Mailing address
103 GARLAND ST, MEDICAL SPECIALTIES, EVERETT, MA 02149-5066
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301069394
MI
207RC0000X
Cardiovascular Disease Physician
Primary
238276
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2168235
—
MA
Enumeration date
05/31/2006
Last updated
02/08/2012
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