Provider Demographics
NPI:1861409989
Name:THAVASEELAN, PERIN SORAB (MD)
Entity type:Individual
Prefix:MRS
First Name:PERIN
Middle Name:SORAB
Last Name:THAVASEELAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PLEASANT VALLEY INTERNISTS PC
Mailing Address - Street 2:60 EAST ST SUITE 1400
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844
Mailing Address - Country:US
Mailing Address - Phone:978-689-0869
Mailing Address - Fax:978-689-3096
Practice Address - Street 1:PLEASANT VALLEY INTERNISTS PC
Practice Address - Street 2:60 EAST ST SUITE 1400
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844
Practice Address - Country:US
Practice Address - Phone:978-689-0869
Practice Address - Fax:978-689-3096
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2009-11-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA55639207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0171557Medicaid
MAD02066Medicare ID - Type UnspecifiedGROUP NBR M20981
MA0171557Medicaid