Basic Information
| Provider Information | |||||||||
| NPI: | 1902190648 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANANTHAKRISHNAN | ||||||||
| FirstName: | NITYA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 FORT WASHINGTON PL | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021394843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019266490 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14 PROSPECT ST | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017573003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084731190 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2011 | ||||||||
| LastUpdateDate: | 07/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | BP10039696 | TX | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | 257926 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.