Basic Information
| Provider Information | |||||||||
| NPI: | 1386635589 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DVORAK | ||||||||
| FirstName: | RAMONA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 JOSLIN PL | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173092400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 JOSLIN PL | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173092400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 02/03/2015 | ||||||||
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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 | 2084P0800X | 56861 | MA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 759563 | 01 | TUFT'S PROVIDER NUMBER | OTHER | 283134 | 01 | MAGELLAN OUT OF NETWORK # | OTHER | 3012389 | 05 | MA | MEDICAID |