Healthcare Provider Details

I. General information

NPI: 1780062158
Provider Name (Legal Business Name): PRIYA KOTHAPALLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 FANNIN ST
HOUSTON TX
77030-2703
US

IV. Provider business mailing address

PO BOX 1666
NEDERLAND TX
77627-1666
US

V. Phone/Fax

Practice location:
  • Phone: 409-504-3145
  • Fax:
Mailing address:
  • Phone: 409-504-3145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberR9996
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: