Phani Kishore Molakatalla, M.D.
Internal Medicine, Gastroenterology in Gardner, MA. Individual provider (NPI-1).
NPI number1861620007
StatusActive
Last updated in NPPESJul 7, 2015
Details
- NPI
- 1861620007
- Entity type
- Individual (NPI-1)
- Name
- Phani Kishore Molakatalla
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jun 25, 2009
- Last updated
- Jul 7, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RG0100X | Internal Medicine, Gastroenterology | 261931 | MA | Yes |
| 207R00000X | Internal Medicine | MD447302 | PA | |
| 390200000X | Student in an Organized Health Care Education/Training Program | MT194411 | PA |
Practice location
250 Green StSuite 209
Gardner, MA 01440-1396
Phone 978-669-5522 · Fax 978-632-0516
Mailing address
250 Green StSuite 209
Gardner, MA 01440-1396
Phone 978-669-5522 · Fax 978-632-0516
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