Basic Information
| Provider Information | |||||||||
| NPI: | 1366477747 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JATHAR | ||||||||
| FirstName: | MEERA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 LOVETT RD | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024593107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178764344 | ||||||||
| FaxNumber: | 6172347913 | ||||||||
| Practice Location | |||||||||
| Address1: | 1575 CAMBRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021384308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178764344 | ||||||||
| FaxNumber: | 6172347913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 02/03/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | MA47212 | MA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 250005856 | 01 | MA | RAILROAD MEDICARE | OTHER |