Provider Demographics
NPI:1528155041
Name:PARVATANENI, SUDHA (MD)
Entity type:Individual
Prefix:MRS
First Name:SUDHA
Middle Name:
Last Name:PARVATANENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 ANDOVER ST
Mailing Address - Street 2:SUITE G8
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845
Mailing Address - Country:US
Mailing Address - Phone:978-975-0990
Mailing Address - Fax:978-975-7803
Practice Address - Street 1:451 ANDOVER ST
Practice Address - Street 2:SUITE G8
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845
Practice Address - Country:US
Practice Address - Phone:978-975-0990
Practice Address - Fax:978-975-0990
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
91550OtherFALLON COMM HEALTH PLANS
30206070OtherEDS N H MEDICAID
MA2099071Medicaid
467973OtherTUFTS HEALTH PLAN
AA28967OtherHARVARD PILGRIM
96849001OtherNETWORK HEALTH PLAN
J28533OtherBCBS OF MASS
3793946OtherAETNA REFF#
7296649OtherPRE CERT#
7296649OtherPRE CERT#
MAA38161Medicare ID - Type Unspecified