Provider Demographics
NPI:1598719056
Name:CHIGURUPATI, RADHIKA (DMD)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:CHIGURUPATI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E NEWTON ST
Mailing Address - Street 2:STE G407
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2308
Mailing Address - Country:US
Mailing Address - Phone:617-638-4350
Mailing Address - Fax:617-638-4365
Practice Address - Street 1:100 E NEWTON ST
Practice Address - Street 2:STE G407
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2308
Practice Address - Country:US
Practice Address - Phone:617-638-4350
Practice Address - Fax:617-638-4365
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA534321223S0112X
MADN18561861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU92450Medicare UPIN