Provider Demographics
NPI:1124215124
Name:POTHINENI, ARAVIND (MD)
Entity Type:Individual
Prefix:
First Name:ARAVIND
Middle Name:
Last Name:POTHINENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 BROADWAY ST STE 205
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4556
Mailing Address - Country:US
Mailing Address - Phone:573-331-7830
Mailing Address - Fax:
Practice Address - Street 1:1723 BROADWAY SUITE 205
Practice Address - Street 2:
Practice Address - City:CAPE GIRADEAU
Practice Address - State:MO
Practice Address - Zip Code:63701
Practice Address - Country:US
Practice Address - Phone:573-331-7830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014012500207RC0200X
NYNA207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine