Provider Demographics
NPI:1164493573
Name:MURTHY, PUTCHA R (MD)
Entity Type:Individual
Prefix:
First Name:PUTCHA
Middle Name:R
Last Name:MURTHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5 NEPONSET ST
Mailing Address - Street 2:WOT 2ND FL, STE C203
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-721-1170
Mailing Address - Fax:508-832-0859
Practice Address - Street 1:385 SOUTHBRIDGE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2498
Practice Address - Country:US
Practice Address - Phone:508-721-1170
Practice Address - Fax:508-832-0859
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2019-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA154313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110058905AMedicaid
7888300OtherAETNA US HEALTHCARE
26852OtherHEALTHY START
991188OtherFALLON COMMUNITY HEALTH P
0401689OtherEVERCARE
784166OtherMVP HEALTH CARE
AA1238OtherHARVARD PILGRIM HEALTHCAR
042472266OtherPRIVATE HEALTHCARE SYSTEM
J18197OtherBLUE CARE ELECT
MA3170594Medicaid
042472266OtherHEALTHCARE VALUE MGMT
110175375OtherRAILROAD MEDICARE
1591940OtherCIGNA HEALTH PLAN
1150239OtherFIRST HEALTH
26852OtherCHILDRENS MED SEC PLAN
J18197OtherBLUE SHIELD HMO BLUE
042472266OtherTHREE RIVERS
J18197OtherBLUE SHIELD INDEMNITY
AA1238OtherHARVARD PILGRIM HEALTHCAR
G53218Medicare UPIN