Healthcare Provider Details

I. General information

NPI: 1699765867
Provider Name (Legal Business Name): MEERA MAHALINGAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY DEPT OF
WEST ROXBURY MA
02132-4927
US

IV. Provider business mailing address

104 COOLIDGE ST
BROOKLINE MA
02446-5808
US

V. Phone/Fax

Practice location:
  • Phone: 857-203-5992
  • Fax:
Mailing address:
  • Phone: 617-251-8369
  • Fax: 508-334-5374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number154499
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number154499
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: