Provider Demographics
NPI:1184662173
Name:PUTHUMANA, KOCHURANI CHERIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KOCHURANI
Middle Name:CHERIAN
Last Name:PUTHUMANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KOCHURANI
Other - Middle Name:C
Other - Last Name:PUTHUMANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:215 TEMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2827
Mailing Address - Country:US
Mailing Address - Phone:804-526-8640
Mailing Address - Fax:
Practice Address - Street 1:215 TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2827
Practice Address - Country:US
Practice Address - Phone:804-526-8640
Practice Address - Fax:804-526-4321
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6034306Medicaid
VA541754080OtherTAX ID
VA041465OtherBCBS/ANTHEM
VA6034306Medicaid
VA041465OtherBCBS/ANTHEM