Healthcare Provider Details

I. General information

NPI: 1316255870
Provider Name (Legal Business Name): MURALI KRISHNA BOGAVALLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2010
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 CENTRE ST
BROCKTON MA
02302-3308
US

IV. Provider business mailing address

246 PLEASANT ST
CONCORD NH
03301-2548
US

V. Phone/Fax

Practice location:
  • Phone: 508-941-7000
  • Fax:
Mailing address:
  • Phone: 603-224-6691
  • Fax: 337-480-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number19999
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number258965
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: