1659667673 NPI number — DR. KSHITIJKUMAR MURLIDHAR AGRAWAL MD

Table of content: DR. KSHITIJKUMAR MURLIDHAR AGRAWAL MD (NPI 1659667673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659667673 NPI number — DR. KSHITIJKUMAR MURLIDHAR AGRAWAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGRAWAL
Provider First Name:
KSHITIJKUMAR
Provider Middle Name:
MURLIDHAR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659667673
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
846 MASSACHUSETTS AVE APT 3D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02476-4713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-779-6500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
736 CAMBRIDGE ST
Provider Second Line Business Practice Location Address:
BONE AND JOINT CENTER
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02135-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-789-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  P78081 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 253777 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com