1962404343 NPI number — SRINIVAS KOTTAPALLY M.D.

Table of content: SRINIVAS KOTTAPALLY M.D. (NPI 1962404343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962404343 NPI number — SRINIVAS KOTTAPALLY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOTTAPALLY
Provider First Name:
SRINIVAS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOTTAPALLY
Provider Other First Name:
SRI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1962404343
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
845 ASHTON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH HUNTINGDON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15642-3999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-603-3676
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 BREWER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15401-8400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-437-2503
Provider Business Practice Location Address Fax Number:
724-437-8846
Provider Enumeration Date:
08/15/2005

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: 2085R0001X , with the licence number:  MD039369L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 470927 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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