Provider Demographics
NPI:1144203126
Name:KAJLA, PETRA (MD)
Entity Type:Individual
Prefix:DR
First Name:PETRA
Middle Name:
Last Name:KAJLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PETRA
Other - Middle Name:
Other - Last Name:FLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1369 GRAFTON ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-2737
Mailing Address - Country:US
Mailing Address - Phone:508-373-7400
Mailing Address - Fax:
Practice Address - Street 1:1369 GRAFTON ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-2737
Practice Address - Country:US
Practice Address - Phone:508-373-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0160890Medicaid
MA0160890Medicaid
MATX2315Medicare PIN