1770092389 NPI number — DR. KEERTHY CHILAKAMARRY DMD

Table of content: DR. KEERTHY CHILAKAMARRY DMD (NPI 1770092389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770092389 NPI number — DR. KEERTHY CHILAKAMARRY DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHILAKAMARRY
Provider First Name:
KEERTHY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

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:
1770092389
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 HIGHLAND AVE APT 40
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MALDEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02148-3638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-606-2148
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 ESSEX ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01840-1411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-327-5151
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2017

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: 1223G0001X , with the licence number:  DN1857756 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DN1857756 , 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)

  • Identifier: DN1857756 . This is a "HEALTH AND HUMAN SERVICES" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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