| Mary C Kannankeril Md.,pa | |
|
170 Changebridge Rd Suite B 3-4 Montville NJ 07045-9115 | |
| (973) 276-0041 | |
| (973) 628-1935 |
| Full Name | Mary C Kannankeril Md.,pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 170 Changebridge Rd, Montville, New Jersey |
| Authorized Official Name and Position | Mary C Kannankeril (OWNER) |
| Authorized Official Contact | 9732760041 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary C Kannankeril Md.,pa 170 Changebridge Rd Suite B 3-4 Montville NJ 07045-9115 Ph: (973) 276-0041 | Mary C Kannankeril Md.,pa 170 Changebridge Rd Suite B 3-4 Montville NJ 07045-9115 Ph: (973) 276-0041 |
| NPI Number | 1538406574 |
|---|---|
| Provider Enumeration Date | 01/10/2013 |
| Last Update Date | 11/20/2023 |
| Certification Date | 11/20/2023 |
| Medicare PECOS PAC ID | 3678726015 |
|---|---|
| Medicare Enrollment ID | O20130114000435 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538406574 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Mary C Kannankeril |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629115126 PECOS PAC ID: 4688622814 Enrollment ID: I20050105000096 |
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