Provider Demographics
NPI:1255389375
Name:KALAHASTHY, KALPANA RAO (MD)
Entity type:Individual
Prefix:
First Name:KALPANA
Middle Name:RAO
Last Name:KALAHASTHY
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 1:3355 BURNS RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4353
Mailing Address - Country:US
Mailing Address - Phone:561-630-5640
Mailing Address - Fax:561-630-2892
Practice Address - Street 1:3355 BURNS RD
Practice Address - Street 2:SUITE 306
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4353
Practice Address - Country:US
Practice Address - Phone:561-630-5640
Practice Address - Fax:561-630-2892
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82696174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH42490Medicare UPIN