Healthcare Provider Details

I. General information

NPI: 1003862988
Provider Name (Legal Business Name): RAFEEQUE A BHADELIA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE BIDMC WCC90
BOSTON MA
02215-5400
US

IV. Provider business mailing address

75 HILLTOP RD
CHESTNUT HILL MA
02467-1806
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-2058
  • Fax: 617-754-2004
Mailing address:
  • Phone: 617-754-2058
  • Fax: 617-754-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number78973
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: