Provider Demographics
NPI:1689647174
Name:ANANTA, PARAKRAMA M (MD)
Entity Type:Individual
Prefix:DR
First Name:PARAKRAMA
Middle Name:M
Last Name:ANANTA
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 1:231 WEAVER ST
Mailing Address - Street 2:UNIT F
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-1338
Mailing Address - Country:US
Mailing Address - Phone:508-679-1400
Mailing Address - Fax:508-679-1449
Practice Address - Street 1:231 WEAVER ST
Practice Address - Street 2:UNIT F
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-1338
Practice Address - Country:US
Practice Address - Phone:508-679-1400
Practice Address - Fax:508-679-1449
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159881208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3200001Medicaid
MAA29705Medicare ID - Type Unspecified
MA3200001Medicaid