=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902291453
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAHUL S. DALAL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2015
-----------------------------------------------------
Last Update Date | 04/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 850 BOYLSTON ST
-----------------------------------------------------
City | CHESTNUT HILL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02467-2477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-732-7426
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 62 13TH ST
-----------------------------------------------------
City | CHARLESTOWN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02129-2056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-726-3884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 292476
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 292476
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------