Individual
IMRAN CHITALWALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
951 TREMONT ST, BOSTON, MA 02120-2210
(617) 708-1686
Mailing address
691 MASSACHUSETTS AVE, APARTMENT 102, BOSTON, MA 02118-4077
(857) 225-7275
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN1857075
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10104875A
MASSHEALTH
MA
Enumeration date
06/26/2014
Last updated
02/10/2016
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