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General NPI Number Information
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NPI Number | 1679611461
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Entity Type | Individual
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Provider Name | VASANT MUKUND THACKER MD
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Gender | Female
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 12/02/2011
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Provider Practice Location Address
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Address Line | 101 MAIN ST #210
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City | MEDFORD
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State | MA
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Zip | 02155-4530
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Country | US
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Telephone | 781-396-8100
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Fax | 781-391-9929
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Provider Business Mailing Address
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Address Line | 3 PINEHURST ROAD
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City | BELMONT
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State | MA
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Zip | 02478-1517
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Country | US
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Telephone | 617-484-3668
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Fax | 781-391-9929
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 39145
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License Number State | MA
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