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General NPI Number Information
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NPI Number | 1699793711
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Entity Type | Organization
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Legal Business Name | PRAKASH G ETTIGI MDPC
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3212 CUTSHAW AVENUE SUITE 303
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City | RICHMOND
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State | VA
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Zip | 23230-5018
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Country | US
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Telephone | 804-353-3324
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Fax | 804-353-4498
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Provider Business Mailing Address
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Address Line | 3212 CUTSHAW AVENUE SUITE 303
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City | RICHMOND
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State | VA
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Zip | 23230-5018
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Country | US
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Telephone | 804-353-3324
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Fax | 804-353-4498
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PRAKASH G ETTIGI
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Credential | MD
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Telephone | 804-353-3324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 0101028834
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License Number State | VA
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