Healthcare Provider Details

I. General information

NPI: 1649436940
Provider Name (Legal Business Name): YAMINI VIRKUD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 CAMBRIDGE ST SUITE 530
BOSTON MA
02114-3108
US

IV. Provider business mailing address

275 CAMBRIDGE ST SUITE 530
BOSTON MA
02114-3108
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-6834
  • Fax: 617-724-2803
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2008018211
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberBOARD ELIGIBLE
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: