Provider Demographics
NPI:1285624668
Name:SHIVDASANI, RAMESH A (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:RAMESH
Middle Name:A
Last Name:SHIVDASANI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BINNEY ST
Mailing Address - Street 2:DANA 720
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6013
Mailing Address - Country:US
Mailing Address - Phone:617-632-5746
Mailing Address - Fax:617-582-8490
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:DANA 720
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6013
Practice Address - Country:US
Practice Address - Phone:617-632-5746
Practice Address - Fax:617-582-8490
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73945207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF02862Medicare UPIN