Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD421262 | PA |
N | 208600000X | Surgeon | MD421262 | PA |
Y | 2086S0129X | Vascular Surgeon | MD421262 | PA |
NPI | 1174623060 |
---|---|
Provider Name | Venkat Amana Kalapatapu |
First Address | Philadelphia, PA 19104-2640 |
Second Address | Philadelphia, PA 19104-2640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 30/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I65958 | (02) | AR |