Healthcare Provider Details

I. General information

NPI: 1932364817
Provider Name (Legal Business Name): NAMRATA NANDAKUMAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CROSS ST STE 201
PEABODY MA
01960-1666
US

IV. Provider business mailing address

39 CROSS ST STE 201
PEABODY MA
01960-1666
US

V. Phone/Fax

Practice location:
  • Phone: 978-854-5090
  • Fax: 978-854-5755
Mailing address:
  • Phone: 978-854-5090
  • Fax: 978-854-5755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number247442
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number232709
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: