=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386859932
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PURNIMA ADLAKHA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1221 MAIN ST STE 117
-----------------------------------------------------
City | HOLYOKE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01040-5396
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-532-8700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1221 MAIN ST STE 117
-----------------------------------------------------
City | HOLYOKE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01040-5396
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-532-8700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PURNIMA ADLAKHA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 413-532-8700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 74341
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------