Individual
PAVAN KUMAR PUNUKOLLU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 GENERAL ST, LAWRENCE, MA 01841-2961
(978) 683-4000
Mailing address
2527 CRANBERRY HWY, WAREHAM, MA 02571-1046
(800) 841-5200
(508) 273-1241
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
269048
MA
2085R0202X
Diagnostic Radiology Physician
35.074221
OH
2085R0202X
Diagnostic Radiology Physician
ME130248
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000241778
ANTHEM BCBS
OH
05
—
110131865A
—
MA
01
—
11286315
CAQH
—
01
—
300132093
RAILROAD MEDICARE
OH
01
—
JA839Z
MEDICARE PTAN
—
Enumeration date
03/24/2006
Last updated
10/16/2025
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