Provider Demographics
NPI:1689737835
Name:KALRA, ANSUYA L (MD)
Entity Type:Individual
Prefix:
First Name:ANSUYA
Middle Name:L
Last Name:KALRA
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 1:2404 S SEACREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-6704
Mailing Address - Country:US
Mailing Address - Phone:561-737-8244
Mailing Address - Fax:561-737-8409
Practice Address - Street 1:2404 S SEACREST BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6704
Practice Address - Country:US
Practice Address - Phone:561-737-8244
Practice Address - Fax:561-737-8409
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42943207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069735400Medicaid
FLD57202Medicare UPIN
FL61351Medicare ID - Type Unspecified