1710969050 NPI number — KALA SEETHARAMAN MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710969050 NPI number — KALA SEETHARAMAN MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SEETHARAMAN

Provider First Name:

KALA

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

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:

1710969050

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/02/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

123 SUMMER ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

WORCESTER

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

01608-1216

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

508-363-5519

Provider Business Mailing Address Fax Number:

508-363-7164

Provider First Line Business Practice Location Address:

115 LINCOLN ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

FRAMINGHAM

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

01702-6358

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

508-383-1000

Provider Business Practice Location Address Fax Number:

508-383-8584

Provider Enumeration Date:

11/14/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RH0003X , with the licence number:  76893 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: J16206 . This is a "BLUE SHIELD HMO BLUE" identifier . This identifiers is of the category "OTHER".
• Identifier: 3000054 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: J16206 . This is a "BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
• Identifier: 0116799 . This is a "CIGNA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 27052 . This is a "HEALTHY START" identifier . This identifiers is of the category "OTHER".
• Identifier: 5352657 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 1061386 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 9901147 . This is a "FALLON COMMUNITY HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: J16206 . This is a "BLUE SHIELD INDEMNITY" identifier . This identifiers is of the category "OTHER".
• Identifier: 27052 . This is a "CHILDRENS MEDICALSECURITY" identifier . This identifiers is of the category "OTHER".
• Identifier: 784230 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: A20399 . This is a "MEDICARE B" identifier . This identifiers is of the category "OTHER".
• Identifier: AA2367 . This is a "HARVARD PILGRIM HEALTH" identifier . This identifiers is of the category "OTHER".