Provider Demographics
NPI:1083905756
Name:KANNABIRAN, VISHNU
Entity Type:Individual
Prefix:
First Name:VISHNU
Middle Name:
Last Name:KANNABIRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MEETING HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2738
Mailing Address - Country:US
Mailing Address - Phone:978-256-5557
Mailing Address - Fax:978-256-1835
Practice Address - Street 1:3 MEETING HOUSE RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2738
Practice Address - Country:US
Practice Address - Phone:978-256-5557
Practice Address - Fax:978-256-1835
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA265940207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology