1639369770 NPI number — DR. LAKSHMAN GUNARATNAM M.D.

Table of content: DR. LAKSHMAN GUNARATNAM M.D. (NPI 1639369770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639369770 NPI number — DR. LAKSHMAN GUNARATNAM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUNARATNAM
Provider First Name:
LAKSHMAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1639369770
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
247 FOREST HILLS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMAICA PLAIN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02130-3302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-447-4293
Provider Business Mailing Address Fax Number:
617-525-5965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 BLACKFAN CIR
Provider Second Line Business Practice Location Address:
#550
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115-5713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-525-5969
Provider Business Practice Location Address Fax Number:
617-525-5965
Provider Enumeration Date:
07/25/2007

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: 207R00000X , with the licence number:  231917 , 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)





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