Provider Demographics
NPI:1023044765
Name:MUTHYALA, UMADEVI (MD)
Entity Type:Individual
Prefix:DR
First Name:UMADEVI
Middle Name:
Last Name:MUTHYALA
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 1:3660 BOULEVARD
Mailing Address - Street 2:SUITE G
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1345
Mailing Address - Country:US
Mailing Address - Phone:804-526-5566
Mailing Address - Fax:804-526-5568
Practice Address - Street 1:3660 BOULEVARD
Practice Address - Street 2:SUITE G
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1345
Practice Address - Country:US
Practice Address - Phone:804-526-5566
Practice Address - Fax:804-526-5568
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006024366208M00000X
VA0101251547207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09633OtherGROUP PTAN