Provider Demographics
NPI:1689055386
Name:KALRA, NIKHIL PRAKASH (MB BCH BAO)
Entity type:Individual
Prefix:DR
First Name:NIKHIL
Middle Name:PRAKASH
Last Name:KALRA
Suffix:
Gender:M
Credentials:MB BCH BAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GYPSY LANE
Mailing Address - Street 2:NORTHSIDE MEDICAL CENTER, ACADEMIC AFFAIRS
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504
Mailing Address - Country:US
Mailing Address - Phone:330-884-1000
Mailing Address - Fax:330-884-0651
Practice Address - Street 1:500 GYPSY LANE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44501
Practice Address - Country:US
Practice Address - Phone:330-884-4250
Practice Address - Fax:330-884-0651
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2018-05-14
Deactivation Date:2016-01-20
Deactivation Code:
Reactivation Date:2016-03-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program