1497734842 NPI number — NAGASAYANA RAO KOTHAPALLI MD

Table of content: NAGASAYANA RAO KOTHAPALLI MD (NPI 1497734842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497734842 NPI number — NAGASAYANA RAO KOTHAPALLI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOTHAPALLI
Provider First Name:
NAGASAYANA
Provider Middle Name:
RAO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOTHAPALLI
Provider Other First Name:
RAO
Provider Other Middle Name:
N
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1497734842
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 767
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILER CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-663-3161
Provider Business Mailing Address Fax Number:
919-663-2212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 EAST 3RD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILER CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-663-3161
Provider Business Practice Location Address Fax Number:
919-663-2212
Provider Enumeration Date:
01/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  24169 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8950236 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50236 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".