Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 0101261258 | VA |
Y | 207QA0505X | Family Doctor - Adult Medicine | D86707 | MD |
NPI | 1033524863 |
---|---|
Provider Name | Chaitanya Korrapati |
First Address | Little Rock, AR 72223-4751 |
Second Address | Salisbury, MD 21801-5422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2014 |
Last Update Date | 15/02/2019 |