Provider Demographics
NPI:1033272661
Name:NARRA, VINOD (MD)
Entity Type:Individual
Prefix:
First Name:VINOD
Middle Name:
Last Name:NARRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 ENDICOTT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3623
Mailing Address - Country:US
Mailing Address - Phone:978-882-6375
Mailing Address - Fax:978-882-6517
Practice Address - Street 1:104 ENDICOTT ST STE 200
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3623
Practice Address - Country:US
Practice Address - Phone:978-882-6375
Practice Address - Fax:978-882-6517
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085261208600000X
MA151643208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI475175910Medicaid
700H262310OtherBLUE CROSS-BLUE CROSS
MAJ17917OtherBCBS
MA110058719AMedicaid
VN085261OtherCHAMPUS-CHAMPUS
VN085261OtherCOMMERCIAL-COMMERCIAL NUMBER
VN085261OtherCOMMERCIAL-COMMERCIAL NUMBER
MAJ17917OtherBCBS
MI475175910Medicaid