Provider Demographics
NPI:1700806304
Name:MURALITHARAN, PUSHKALA
Entity Type:Individual
Prefix:DR
First Name:PUSHKALA
Middle Name:
Last Name:MURALITHARAN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:PUSHKALA
Other - Middle Name:
Other - Last Name:MURALI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:253 PLEASANT STREET
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-226-6113
Mailing Address - Fax:602-229-5009
Practice Address - Street 1:253 PLEASANT STREET
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-226-6113
Practice Address - Fax:602-229-5009
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010619Medicaid
NH30010619Medicaid
NHMX4872Medicare PIN