Provider Demographics
NPI:1245287937
Name:TANDON, VIBHA (MD)
Entity type:Individual
Prefix:
First Name:VIBHA
Middle Name:
Last Name:TANDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-1628
Mailing Address - Country:US
Mailing Address - Phone:617-320-1557
Mailing Address - Fax:
Practice Address - Street 1:541 HIGH ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-1628
Practice Address - Country:US
Practice Address - Phone:617-320-1557
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA46213207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology