Healthcare Provider Details

I. General information

NPI: 1548526833
Provider Name (Legal Business Name): VINAY SHANKAR KOTHAPALLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S MACGREGOR WAY
HOUSTON TX
77021-1032
US

IV. Provider business mailing address

1941 EAST RD
HOUSTON TX
77054-6010
US

V. Phone/Fax

Practice location:
  • Phone: 713-741-5000
  • Fax: 713-741-6909
Mailing address:
  • Phone: 713-486-2700
  • Fax: 713-486-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberS1434
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: