Provider Demographics
NPI:1376528315
Name:KALYANPUR, ARJUN (MD)
Entity Type:Individual
Prefix:DR
First Name:ARJUN
Middle Name:
Last Name:KALYANPUR
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 1:22 LLANFAIR RD UNIT 6
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2320
Mailing Address - Country:US
Mailing Address - Phone:610-785-6327
Mailing Address - Fax:775-242-2409
Practice Address - Street 1:22 LLANFAIR RD UNIT 6
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2320
Practice Address - Country:US
Practice Address - Phone:610-785-6327
Practice Address - Fax:775-242-2409
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA810372085R0202X
CT348242085R0202X
PAMD4183272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G78858Medicare UPIN