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General NPI Number Information
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NPI Number | 1649385733
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Entity Type | Individual
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Provider Name | JAGAN KOTHAPALLY M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 08/07/2018
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Provider Practice Location Address
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Address Line | 2091 LANGHORNE RD
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City | LYNCHBURG
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State | VA
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Zip | 24501
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Country | US
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Telephone | 434-947-3954
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Fax | 434-947-5944
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Provider Business Mailing Address
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Address Line | 2140 KINGSLEY AVE STE 10
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City | ORANGE PARK
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State | FL
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Zip | 32073-5129
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Country | US
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Telephone | 904-529-5252
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Fax | 904-529-5253
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | ME115829
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License Number State | FL
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