Provider Demographics
NPI:1427189653
Name:KOTHANDAPANI, VIRUPAKSHA (PHD)
Entity Type:Individual
Prefix:DR
First Name:VIRUPAKSHA
Middle Name:
Last Name:KOTHANDAPANI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 CHESTER COURT
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-4638
Mailing Address - Country:US
Mailing Address - Phone:251-344-1902
Mailing Address - Fax:
Practice Address - Street 1:3263 DEMETROPOLIS RD
Practice Address - Street 2:SUITE NO 7
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-3304
Practice Address - Country:US
Practice Address - Phone:251-666-7765
Practice Address - Fax:251-666-6514
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL215103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51070396OtherB CROSS B SHIELD
R75622Medicare UPIN