Provider Demographics
NPI:1922597285
Name:COORAY, MUTHUTANTRIGE HARINE (MD)
Entity Type:Individual
Prefix:
First Name:MUTHUTANTRIGE
Middle Name:HARINE
Last Name:COORAY
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 1:590 COURT STREET
Mailing Address - Street 2:DARTMOUTH-HITCHCOCK CLINIC
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431
Mailing Address - Country:US
Mailing Address - Phone:603-354-6762
Mailing Address - Fax:915-757-0720
Practice Address - Street 1:590 COURT STREET
Practice Address - Street 2:DARTMOUTH-HITCHCOCK CLINIC
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431
Practice Address - Country:US
Practice Address - Phone:603-354-6762
Practice Address - Fax:915-757-0720
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NH21303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program