{
"Npi": {
"NPI": "1912364563",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MULPUR",
"FirstName": "SIRISH KANT",
"MiddleName": "SURESH",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MULPUR",
"OtherFirstName": "SIRISH",
"OtherMiddleName": null,
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "SIRISH MULPURA, MD",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "11815 FOUNTAIN WAY STE 300",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEWPORT NEWS",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23606-4448",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "757-734-5534",
"MailingAddressFaxNumber": "757-734-5534",
"FirstLinePracticeLocationAddress": "11815 FOUNTAIN WAY STE 300",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEWPORT NEWS",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23606-4448",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "757-734-5534",
"PracticeLocationAddressFaxNumber": "757-734-5534",
"EnumerationDate": "01/26/2016",
"LastUpdateDate": "06/04/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2084P0800X",
"TaxonomyName": "Psychiatry Physician",
"LicenseNumber": "131041",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2084P0800X",
"TaxonomyName": "Psychiatry Physician",
"LicenseNumber": "58182",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2084P0800X",
"TaxonomyName": "Psychiatry Physician",
"LicenseNumber": "0101267222",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}