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General NPI Number Information
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NPI Number | 1992901433
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Entity Type | Individual
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Provider Name | GERONAMI PAUL KATTUPALLI MD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 12/19/2018
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Provider Practice Location Address
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Address Line | 341 SCIENCE PARK RD STE 202
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City | STATE COLLEGE
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State | PA
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Zip | 16803-2287
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Country | US
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Telephone | 814-424-2095
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Fax | 814-424-2202
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Provider Business Mailing Address
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Address Line | 175 BARRENS CT STE 100
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City | PORT MATILDA
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State | PA
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Zip | 16870-7043
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Country | US
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Telephone | 814-777-1071
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Fax | 814-424-2202
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MT189831
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD440359
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License Number State | PA
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