Provider Demographics
NPI:1134118144
Name:KROTTAPALLI, KAVITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVITHA
Middle Name:
Last Name:KROTTAPALLI
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:PO BOX 72665
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-8017
Mailing Address - Country:US
Mailing Address - Phone:804-560-8828
Mailing Address - Fax:804-560-8783
Practice Address - Street 1:1570 EARLY SETTLERS RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4458
Practice Address - Country:US
Practice Address - Phone:804-560-8785
Practice Address - Fax:804-560-8783
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VABK8866660OtherDEA
VAI13645Medicare UPIN
VA008132C14Medicare ID - Type Unspecified