Provider Demographics
NPI:1295714806
Name:BATRA, KERRI LYNN (MD)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:LYNN
Last Name:BATRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:LYNN
Other - Last Name:FEDORCHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 INDUSTRIAL RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3588
Mailing Address - Country:US
Mailing Address - Phone:508-473-1480
Mailing Address - Fax:508-473-1210
Practice Address - Street 1:12 UXBRIDGE RD
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:MA
Practice Address - Zip Code:01756-1094
Practice Address - Country:US
Practice Address - Phone:508-634-6620
Practice Address - Fax:508-634-6813
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12559207RR0500X
MA217944207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIKB69254Medicaid
RI007059970Medicare PIN