Healthcare Provider Details

I. General information

NPI: 1629238308
Provider Name (Legal Business Name): TARUN MAHAJAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDREN'S HOSPITAL 300 LONGWOOD AVENUE
BOSTON MA
02115
US

IV. Provider business mailing address

108 CONCORD AVE APT 3
SOMERVILLE MA
02143-4347
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6363
  • Fax:
Mailing address:
  • Phone: 617-355-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number236285
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: