Provider Demographics
NPI:1740219534
Name:POLU, KALPANA R (MD)
Entity Type:Individual
Prefix:DR
First Name:KALPANA
Middle Name:R
Last Name:POLU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KALPANA
Other - Middle Name:
Other - Last Name:YALALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 LU STUBBS LN
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2368
Mailing Address - Country:US
Mailing Address - Phone:781-784-7325
Mailing Address - Fax:
Practice Address - Street 1:345 BLACKSTONE BLVD
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4800
Practice Address - Country:US
Practice Address - Phone:401-456-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2125992084P0804X
RIMD160622084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A36407Medicare ID - Type Unspecified
G38140Medicare UPIN