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General NPI Number Information
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NPI Number | 1942594924
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Entity Type | Individual
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Provider Name | KINGSLEY PRAKASH ANAND PUDOTA MD
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Gender | Male
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Dates
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Enumeration Date | 06/07/2011
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Last Update Date | 09/09/2022
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Provider Practice Location Address
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Address Line | 3110 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-1210
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Country | US
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Telephone | 304-388-5590
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Fax | 304-388-8238
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Provider Business Mailing Address
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Address Line | 3110 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-1210
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Country | US
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Telephone | 304-388-5590
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Fax | 304-388-8238
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101256996
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 2015-02195
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2015-02195
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25957
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License Number State | WV
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