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General NPI Number Information
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NPI Number | 1912364563
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Entity Type | Individual
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Provider Name | SIRISH KANT SURESH MULPUR MD
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Gender | Male
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 11815 FOUNTAIN WAY STE 300
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4448
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Country | US
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Telephone | 757-734-5534
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Fax | 757-734-5534
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Provider Business Mailing Address
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Address Line | 11815 FOUNTAIN WAY STE 300
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4448
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Country | US
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Telephone | 757-734-5534
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Fax | 757-734-5534
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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 | 131041
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 58182
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101267222
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License Number State | VA
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