Provider Demographics
NPI:1760444137
Name:CHALOORI, PRATHIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRATHIMA
Middle Name:
Last Name:CHALOORI
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 1:140 HAVERHILL ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-1550
Mailing Address - Country:US
Mailing Address - Phone:978-269-0030
Mailing Address - Fax:978-269-0020
Practice Address - Street 1:140 HAVERHILL ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-1550
Practice Address - Country:US
Practice Address - Phone:978-269-0030
Practice Address - Fax:978-269-0020
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079051207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4688978Medicaid
MI4688969Medicaid
MI4688978Medicaid
I20681Medicare UPIN