Healthcare Provider Details

I. General information

NPI: 1528368420
Provider Name (Legal Business Name): PRAGATI TIKOO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CRAFTS ST STE 400
NEWTON MA
02458-1393
US

IV. Provider business mailing address

11913 NE 195TH ST
BOTHELL WA
98011-3147
US

V. Phone/Fax

Practice location:
  • Phone: 617-964-7530
  • Fax: 617-964-2667
Mailing address:
  • Phone: 425-489-3100
  • Fax: 425-489-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number60701866
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number247135
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: