Provider Demographics
NPI:1144230590
Name:K SIRIPALA MD & ASSOC INC
Entity Type:Organization
Organization Name:K SIRIPALA MD & ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KUMBALATARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIRIPALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-946-3500
Mailing Address - Street 1:312 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4911
Mailing Address - Country:US
Mailing Address - Phone:814-946-3500
Mailing Address - Fax:814-946-5067
Practice Address - Street 1:312 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4911
Practice Address - Country:US
Practice Address - Phone:814-946-3500
Practice Address - Fax:814-946-5067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007473940011Medicaid
PA1007473940011Medicaid