Provider Demographics
NPI:1366511271
Name:KOTTAPALLI, MAHIJA (MD)
Entity type:Individual
Prefix:DR
First Name:MAHIJA
Middle Name:
Last Name:KOTTAPALLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 LESLIE PL
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-8901
Mailing Address - Country:US
Mailing Address - Phone:304-757-0639
Mailing Address - Fax:
Practice Address - Street 1:1401 HOSPITAL DR
Practice Address - Street 2:SUITE # 201
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9237
Practice Address - Country:US
Practice Address - Phone:304-757-4032
Practice Address - Fax:304-757-3026
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV211832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000361Medicaid
WV4139551Medicare PIN