Healthcare Provider Details

I. General information

NPI: 1770924466
Provider Name (Legal Business Name): VIMAL HASMUKH PRAJAPATI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE DERMATOLOGY PROGRAM
BOSTON MA
02115-5724
US

IV. Provider business mailing address

1365 BOYLSTON ST APARTMENT 845
BOSTON MA
02215-3912
US

V. Phone/Fax

Practice location:
  • Phone: 617-580-1982
  • Fax:
Mailing address:
  • Phone: 617-580-1982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number256655
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: