Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD431213 | PA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MT184710 | PA |
N | 207YP0228X | Pediatric Otolaryngology | 25MA08862500 | NJ |
Y | 207YP0228X | Pediatric Otolaryngology | MD431213 | PA |
NPI | 1891851812 |
---|---|
Provider Name | Sri Kiran Chennupati |
First Address | Philadelphia, PA 19178-3311 |
Second Address | Allentown, PA 18103-6229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 26/02/2016 |