1366436214 NPI number — ANITHA R KUCHIPUDI M.D.

Table of content: ANITHA R KUCHIPUDI M.D. (NPI 1366436214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366436214 NPI number — ANITHA R KUCHIPUDI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUCHIPUDI
Provider First Name:
ANITHA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366436214
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 WINDHAM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PELHAM
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03076-2372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-635-5400
Provider Business Mailing Address Fax Number:
603-635-5499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 WINDHAM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PELHAM
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03076-2372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-635-5400
Provider Business Practice Location Address Fax Number:
603-635-5499
Provider Enumeration Date:
09/07/2005

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: 207R00000X , with the licence number:  11197 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30201517 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110217963 . This is a "RR MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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