Provider Demographics
NPI:1285193268
Name:KROTHAPALLI, PETER KRISHNA (DO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:KRISHNA
Last Name:KROTHAPALLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 PINE ST STE 309
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1136
Mailing Address - Country:US
Mailing Address - Phone:334-262-0342
Mailing Address - Fax:
Practice Address - Street 1:1722 PINE ST STE 309
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1136
Practice Address - Country:US
Practice Address - Phone:334-262-0342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALDO.2975207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program