Provider Demographics
NPI:1912972704
Name:PUNURI, JAYALAKSHMI (MD)
Entity Type:Individual
Prefix:
First Name:JAYALAKSHMI
Middle Name:
Last Name:PUNURI
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 1:464 HILLSIDE AVE
Mailing Address - Street 2:304
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1227
Mailing Address - Country:US
Mailing Address - Phone:508-754-0758
Mailing Address - Fax:508-754-0739
Practice Address - Street 1:235 NORTH PEARL ST
Practice Address - Street 2:CARITAS GOOD SAMARITAN MEDICAL CENTER
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-427-2335
Practice Address - Fax:508-588-8144
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA223265208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA27254OtherHPHC
MAJ28370OtherBCBS
MAAA27254OtherHPHC
A38031Medicare ID - Type Unspecified