Healthcare Provider Details

I. General information

NPI: 1285026062
Provider Name (Legal Business Name): KAVITA TRIPATHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 EXECUTIVE DR STE H
DANVILLE VA
24541-4155
US

IV. Provider business mailing address

125 EXECUTIVE DR STE H
DANVILLE VA
24541-4155
US

V. Phone/Fax

Practice location:
  • Phone: 434-791-1345
  • Fax: 434-773-6811
Mailing address:
  • Phone: 434-791-1345
  • Fax: 434-773-6811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberL.4132R
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101261601
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: