Healthcare Provider Details

I. General information

NPI: 1962854737
Provider Name (Legal Business Name): KRISHNA KISHORE UMAPATHI MBBS, MD, MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PENNSYLVANIA AVE STE 103
CHARLESTON WV
25302-3351
US

IV. Provider business mailing address

800 PENNSYLVANIA AVE
CHARLESTON WV
25302-3351
US

V. Phone/Fax

Practice location:
  • Phone: 216-309-5642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.028502
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number036149860
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number31201
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: