Healthcare Provider Details

I. General information

NPI: 1376528315
Provider Name (Legal Business Name): ARJUN KALYANPUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 LLANFAIR RD UNIT 6
ARDMORE PA
19003-2320
US

IV. Provider business mailing address

22 LLANFAIR RD UNIT 6
ARDMORE PA
19003-2320
US

V. Phone/Fax

Practice location:
  • Phone: 610-785-6327
  • Fax: 775-242-2409
Mailing address:
  • Phone: 610-785-6327
  • Fax: 775-242-2409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA81037
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number34824
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD418327
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: