Provider Demographics
NPI:1467494849
Name:KAMALAPUR, VIDYA (MD)
Entity Type:Individual
Prefix:
First Name:VIDYA
Middle Name:
Last Name:KAMALAPUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 JEFFERSON DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-5103
Mailing Address - Country:US
Mailing Address - Phone:601-445-4616
Mailing Address - Fax:601-446-9834
Practice Address - Street 1:150 JEFFERSON DAVIS BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5107
Practice Address - Country:US
Practice Address - Phone:601-445-4616
Practice Address - Fax:601-446-9834
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18435207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1622176Medicaid
MS07809303Medicaid
MS050000780Medicare ID - Type Unspecified