Healthcare Provider Details

I. General information

NPI: 1124523311
Provider Name (Legal Business Name): DR. VARSHA RADHAKRISHNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVENUE, RABB-2 BIDMC HARVARD PSYCHIATRY RESIDENCY TRAINING PROGRAM
BOSTON MA
02215
US

IV. Provider business mailing address

330 BROOKLINE AVE # RABB2
BOSTON MA
02215-5400
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-1029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number276611
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: