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NPI Code Detail

MEDICARE: MANISH TANDON MD

MEDICARE: MANISH TANDON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0100XGastroenterology Physician155573MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1J24432OTHERMABCBS MA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417021437
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANISH TANDON MD
Provider Business Mailing Address
First Line : 230 HIGHLAND AVE
Second Line : MEDICAL SPECIALTIES
City : SOMERVILLE
State : MA
Zip : 02143-1408
Country : US
Telephone Number : 617-665-1552
Fax Number :
Provider Business Practice Location Address
First Line : 230 HIGHLAND AVE
Second Line : MEDICAL SPECIALTIES
City : SOMERVILLE
State : MA
Zip : 02143-1408
Country : US
Telephone Number : 617-665-1552
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2006
Last Update Date : 11/15/2007

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