Provider Demographics
NPI:1134357924
Name:TALLEDO THAIS, KARLA A (MD)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:A
Last Name:TALLEDO THAIS
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:960 MASSACHUSETTS AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 ALBANY ST, STE 9B & C
Practice Address - Street 2:SHAPIRO BLDG - INFECTIOUS DISEASES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2526
Practice Address - Country:US
Practice Address - Phone:617-414-4290
Practice Address - Fax:617-414-4285
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2024-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA257969207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3125569Medicaid
MA110101051AMedicaid