Active NPI
Thanissara Chansakul, M.D.
- Internal Medicine Physician
- Cambridge, MA
National Provider Identifier
1457635252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 247991
- Practice address
- 330 Mount Auburn St
Department of Medicine
Cambridge, MA 02138-5502 - Phone
- (267) 421-9774
- NPI assigned
- Sep 28, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 247991 | MA | Primary |
Addresses
Primary practice location
330 Mount Auburn St
Department of Medicine
Cambridge, MA 02138-5502
Mailing address
20 Cameron St
Unit 303
Brookline, MA 02445-7647
Phone (267) 421-9774
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 247991 | MA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317168000000",
"number": "1457635252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 CAMERON ST",
"address_2": "UNIT 303",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024457647",
"telephone_number": "267-421-9774"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "330 MOUNT AUBURN ST",
"address_2": "DEPARTMENT OF MEDICINE",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021385502",
"telephone_number": "267-421-9774"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHANSAKUL",
"first_name": "THANISSARA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-09-28",
"last_updated": "2011-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MA",
"license": "247991",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.