Individual
PHANI KISHORE MOLAKATALLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
250 GREEN ST, SUITE 209, GARDNER, MA 01440-1396
(978) 669-5522
(978) 632-0516
Mailing address
250 GREEN ST, SUITE 209, GARDNER, MA 01440-1396
(978) 669-5522
(978) 632-0516
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD447302
PA
207RG0100X
Gastroenterology Physician
Primary
261931
MA
390200000X
Student in an Organized Health Care Education/Training Program
MT194411
PA
Other
Enumeration date
06/25/2009
Last updated
07/07/2015
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