Healthcare Provider Details

I. General information

NPI: 1841299716
Provider Name (Legal Business Name): KALYANI THANGARAJ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 CANTON ST SUITE 325
WESTWOOD MA
02090
US

IV. Provider business mailing address

68 N MAIN ST
CARVER MA
02330-1128
US

V. Phone/Fax

Practice location:
  • Phone: 781-407-7713
  • Fax:
Mailing address:
  • Phone: 508-747-7813
  • Fax: 508-747-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number46471
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number46471
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: