Provider Demographics
NPI:1992979645
Name:THANAWALA, RUCHI (MD)
Entity type:Individual
Prefix:DR
First Name:RUCHI
Middle Name:
Last Name:THANAWALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RUCHI
Other - Middle Name:
Other - Last Name:THANAWALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MS
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3098
Mailing Address - Country:US
Mailing Address - Phone:503-494-7820
Mailing Address - Fax:503-494-7829
Practice Address - Street 1:BAYSTATE MEDICAL CENTER
Practice Address - Street 2:759 CHESTNUT ST
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199-0001
Practice Address - Country:US
Practice Address - Phone:413-794-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61258693208600000X, 208G00000X
ORMD201559208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery