MEDICARE: DR. BALAJI PADMANABAN ATHREYA M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0005X	Hypertension Specialist Physician	039023	CT
2	207RN0300X	Nephrology Physician	204517	MA
3	207RN0300X	Nephrology Physician	039023	CT
4	207RH0005X	Hypertension Specialist Physician	204517	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598745010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BALAJI PADMANABAN ATHREYA M.D

Provider Business Mailing Address
First Line	:	100 WASON AVE
Second Line	:	STE 200
City	:	SPRINGFIELD
State	:	MA
Zip	:	01107-1179
Country	:	US
Telephone Number	:	413-733-9666
Fax Number	:	413-750-3432

Provider Business Practice Location Address
First Line	:	100 WASON AVE
Second Line	:	SUITE 200
City	:	SPRINGFIELD
State	:	MA
Zip	:	01107-1381
Country	:	US
Telephone Number	:	413-733-9666
Fax Number	:	413-750-3432

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	05/15/2019

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Directions to “ DR. BALAJI PADMANABAN ATHREYA M.D” Practice Location

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