Healthcare Provider Details

I. General information

NPI: 1487772083
Provider Name (Legal Business Name): MANISH TANDON, MD,ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MOUNT AUBURN ST SUITE 406
CAMBRIDGE MA
02138-5600
US

IV. Provider business mailing address

300 MOUNT AUBURN ST SUITE 406
CAMBRIDGE MA
02138-5600
US

V. Phone/Fax

Practice location:
  • Phone: 617-562-0500
  • Fax: 617-562-0600
Mailing address:
  • Phone: 617-562-0500
  • Fax: 617-562-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number115573
License Number StateMA

VIII. Authorized Official

Name: MANISH TANDON
Title or Position: DOCTOR
Credential: M.D., P.C.
Phone: 617-562-0500