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General NPI Number Information
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NPI Number | 1912110495
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Entity Type | Individual
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Provider Name | AJAY S KUCHIBHATLA MD
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Gender | Male
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 05/11/2020
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Provider Practice Location Address
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Address Line | 400 MEDICAL DR STE B
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City | HAMPTON
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State | VA
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Zip | 23666-1767
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Country | US
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Telephone | 757-788-0473
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Fax |
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Provider Business Mailing Address
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Address Line | 400 MEDICAL DR STE B
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City | HAMPTON
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State | VA
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Zip | 23666-1767
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Country | US
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Telephone | 757-788-0473
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101244871
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License Number State | VA
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