Provider Demographics
NPI:1386837342
Name:KUCHACULLA, VISHAL REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:VISHAL
Middle Name:REDDY
Last Name:KUCHACULLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:819 WORCESTER ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1045
Mailing Address - Country:US
Mailing Address - Phone:413-543-6820
Mailing Address - Fax:413-543-7962
Practice Address - Street 1:819 WORCESTER ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01151-1045
Practice Address - Country:US
Practice Address - Phone:413-543-6820
Practice Address - Fax:413-543-7962
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD436247207R00000X
MA238378207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110087930AMedicaid
MA0020391Medicare PIN
PA9896298OtherAETNA
PA147857Medicare PIN