Provider Demographics
NPI:1760459176
Name:KRISHNAMOORTHY, KALPATHY S (MD)
Entity Type:Individual
Prefix:DR
First Name:KALPATHY
Middle Name:S
Last Name:KRISHNAMOORTHY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-3877
Mailing Address - Fax:617-726-7860
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAW 6, PEDIATRIC NEUROLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-3877
Practice Address - Fax:617-724-7860
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2013-03-07
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Provider Licenses
StateLicense IDTaxonomies
MA36248208000000X
MN362482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA700053OtherTUFTS HEALTH PLAN
MA2033135Medicaid
MAM08904OtherBCBS MA
MAM08904Medicare PIN
B77239Medicare UPIN