Healthcare Provider Details

I. General information

NPI: 1215999362
Provider Name (Legal Business Name): KANCHANMALA KATAPADI MD, INTERNAL MEDICIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 02/05/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 7TH AVENUE GROUND FLOOR
BROOKLYN NY
11215
US

IV. Provider business mailing address

459 7TH AVENUE GROUND FLOOR
BROOKLYN NY
11215
US

V. Phone/Fax

Practice location:
  • Phone: 718-832-1964
  • Fax: 718-832-0526
Mailing address:
  • Phone: 718-832-1964
  • Fax: 718-832-0526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number204043
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number204043
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: