Healthcare Provider Details

I. General information

NPI: 1366511271
Provider Name (Legal Business Name): MAHIJA KOTTAPALLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HOSPITAL DR SUITE # 201
HURRICANE WV
25526-9237
US

IV. Provider business mailing address

129 LESLIE PL
SCOTT DEPOT WV
25560-8901
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-4032
  • Fax: 304-757-3026
Mailing address:
  • Phone: 304-757-0639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number21183
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: