Provider Demographics
NPI:1598745010
Name:ATHREYA, BALAJI PADMANABAN (MD)
Entity type:Individual
Prefix:DR
First Name:BALAJI
Middle Name:PADMANABAN
Last Name:ATHREYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BALAJI
Other - Middle Name:
Other - Last Name:PADMANABHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 WASON AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1179
Mailing Address - Country:US
Mailing Address - Phone:413-733-9666
Mailing Address - Fax:413-750-3432
Practice Address - Street 1:100 WASON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1381
Practice Address - Country:US
Practice Address - Phone:413-733-9666
Practice Address - Fax:413-750-3432
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039023207RH0005X, 207RN0300X
MA204517207RN0300X, 207RH0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension Specialist
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0105881Medicaid
QX7483Medicare PIN
MAH19661Medicare UPIN