Provider Demographics
NPI:1740604941
Name:GUNACHELVAN, KARTHIK
Entity Type:Individual
Prefix:DR
First Name:KARTHIK
Middle Name:
Last Name:GUNACHELVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 BICENTENNIAL HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118
Mailing Address - Country:US
Mailing Address - Phone:413-733-4101
Mailing Address - Fax:413-796-6821
Practice Address - Street 1:305 BICENTENNIAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118
Practice Address - Country:US
Practice Address - Phone:413-733-4101
Practice Address - Fax:413-796-6821
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA267015207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110117532/AMedicaid
MA110117532/AMedicaid