Provider Demographics
NPI:1598014979
Name:PHATAK, UMA R (MD)
Entity type:Individual
Prefix:
First Name:UMA
Middle Name:R
Last Name:PHATAK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:720 HARRISON AVENUE
Mailing Address - Street 2:DOB 503
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2371
Mailing Address - Country:US
Mailing Address - Phone:617-414-5405
Mailing Address - Fax:617-414-6031
Practice Address - Street 1:830 HARRISON AVENUE
Practice Address - Street 2:MOAKLEY, SUITE 3400
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2905
Practice Address - Country:US
Practice Address - Phone:617-414-8060
Practice Address - Fax:617-414-8457
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2020-02-05
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Provider Licenses
StateLicense IDTaxonomies
MA272638208600000X
TXP1208208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery