Provider Demographics
NPI:1881870400
Name:KALAVA, KALYAN (MD)
Entity type:Individual
Prefix:
First Name:KALYAN
Middle Name:
Last Name:KALAVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 GREEN ST
Mailing Address - Street 2:SPINE AND PAIN CARE CENTER
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-1336
Mailing Address - Country:US
Mailing Address - Phone:978-630-5045
Mailing Address - Fax:978-630-5046
Practice Address - Street 1:242 GREEN ST
Practice Address - Street 2:SPINE AND PAIN CARE CENTER
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-1336
Practice Address - Country:US
Practice Address - Phone:978-630-5045
Practice Address - Fax:978-630-5046
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA234458207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0188476Medicaid