Provider Demographics
NPI:1558471227
Name:ACHARYA, KALPANA RAVINDRA (MD)
Entity Type:Individual
Prefix:
First Name:KALPANA
Middle Name:RAVINDRA
Last Name:ACHARYA
Suffix:
Gender:F
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:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:DUDLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01571
Mailing Address - Country:US
Mailing Address - Phone:508-765-9167
Mailing Address - Fax:508-764-2462
Practice Address - Street 1:29 PINE STREET
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:21550
Practice Address - Country:US
Practice Address - Phone:508-765-9167
Practice Address - Fax:508-764-2462
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA369982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA300040Medicaid
N01934Medicare UPIN
MA300040Medicaid