Provider Demographics
NPI:1346397833
Name:PALAKURTHI, HIMA B (MD)
Entity Type:Individual
Prefix:
First Name:HIMA
Middle Name:B
Last Name:PALAKURTHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HIMA
Other - Middle Name:
Other - Last Name:JAVANGULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5904 NORWOOD KNOLLS WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8296
Mailing Address - Country:US
Mailing Address - Phone:919-414-1334
Mailing Address - Fax:919-414-1334
Practice Address - Street 1:5904 NORWOOD KNOLLS WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8296
Practice Address - Country:US
Practice Address - Phone:919-414-1334
Practice Address - Fax:919-414-1334
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-000302084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905884Medicaid
NC2063418Medicare PIN