Healthcare Provider Details

I. General information

NPI: 1710973987
Provider Name (Legal Business Name): RAGHAVENDRA KULKARNI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 11/27/2023
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 ROBERTS DR STE 313
NORTH ADAMS MA
01247-3254
US

IV. Provider business mailing address

PO BOX 397
DOVER MA
02030-0397
US

V. Phone/Fax

Practice location:
  • Phone: 413-398-5732
  • Fax:
Mailing address:
  • Phone: 617-480-4356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number203310
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: