Healthcare Provider Details

I. General information

NPI: 1063512804
Provider Name (Legal Business Name): DWARAKANATH VUPPALAPATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 N. MINNESOTA ST.
CARSON CITY NV
89703
US

IV. Provider business mailing address

PO BOX 1811
CARSON CITY NV
89702-1811
US

V. Phone/Fax

Practice location:
  • Phone: 775-445-7354
  • Fax: 775-888-6233
Mailing address:
  • Phone: 775-445-7354
  • Fax: 775-885-4795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10804
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number10804
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number10804
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number10804
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: