Provider Demographics
NPI:1932197266
Name:CHIRASEVINUPRAPHAND, PRAMODHYA (MD)
Entity Type:Individual
Prefix:MR
First Name:PRAMODHYA
Middle Name:
Last Name:CHIRASEVINUPRAPHAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:PRAMOD
Other - Middle Name:
Other - Last Name:CHIRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:259 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-2115
Mailing Address - Country:US
Mailing Address - Phone:508-881-4368
Mailing Address - Fax:508-881-6300
Practice Address - Street 1:259 MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MA
Practice Address - Zip Code:01721-2115
Practice Address - Country:US
Practice Address - Phone:508-881-4368
Practice Address - Fax:508-881-6300
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA041470207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0103934Medicaid
MA0103934Medicaid
B77211Medicare UPIN