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NPI Code Detail

MEDICARE: DR. NIRMALA KETHINENI M.D.

MEDICARE: DR. NIRMALA KETHINENI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianM1430TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891824686
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NIRMALA KETHINENI M.D.
Provider Business Mailing Address
First Line : PO BOX 392929
Second Line :
City : PITTSBURGH
State : PA
Zip : 15251-9900
Country : US
Telephone Number : 713-461-2915
Fax Number : 713-461-5307
Provider Business Practice Location Address
First Line : 20675 FM 1093 RD STE A
Second Line :
City : RICHMOND
State : TX
Zip : 77407-7778
Country : US
Telephone Number : 713-461-2915
Fax Number : 713-461-5307
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 06/13/2024

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