Healthcare Provider Details

I. General information

NPI: 1508005232
Provider Name (Legal Business Name): VINAY SUBHASH MAHAJAN M.B.B.S, PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST BRIGHAM AND WOMEN'S HOSPITAL, DEPARTMENT OF PATHOLOGY
BOSTON MA
02115-6110
US

IV. Provider business mailing address

75 FRANCIS ST BRIGHAM AND WOMEN'S HOSPITAL, DEPARTMENT OF PATHOLOGY
BOSTON MA
02115-6110
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number253732
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: