Active NPI
Deepak Sham Tandon, M.D.
- Neurology Physician
- Boston, MA
National Provider Identifier
1083797492
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 46565
- Practice address
- 125 Parker Hill
Boston, MA 02120 - Phone
- (617) 731-0016
- Fax
- (617) 739-6866
- NPI assigned
- Oct 23, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 46565 | MA | Primary |
Addresses
Primary practice location
125 Parker Hill
Boston, MA 02120
Mailing address
125 Parker Hill
Boston, MA 02120
Phone (617) 731-0016
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 92688 | Other | MA | AETNA |
| 706450 | Other | MA | TUFTS |
| 11151 | Other | MA | HPHC |
| VC6000170977 | Other | MA | COMMONWEALTH OF MA |
| M14268 | Other | MA | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083797492",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 PARKER HILL",
"city": "BOSTON",
"state": "MA",
"postal_code": "02120",
"telephone_number": "617-731-0016",
"fax_number": "617-739-6866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 PARKER HILL",
"city": "BOSTON",
"state": "MA",
"postal_code": "02120",
"telephone_number": "617-731-0016",
"fax_number": "617-739-6866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANDON",
"first_name": "DEEPAK",
"middle_name": "SHAM",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MA",
"license": "46565",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "92688",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "706450",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HPHC",
"identifier": "11151",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMONWEALTH OF MA",
"identifier": "VC6000170977",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "M14268",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.