Provider Demographics
NPI:1487844148
Name:TUMPATI, PRABHAKARA RAO (MD)
Entity Type:Individual
Prefix:DR
First Name:PRABHAKARA
Middle Name:RAO
Last Name:TUMPATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 WELSH RD
Mailing Address - Street 2:2ND FLOOR, STE C
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4213
Mailing Address - Country:US
Mailing Address - Phone:215-676-2334
Mailing Address - Fax:215-676-2366
Practice Address - Street 1:1718 WELSH RD
Practice Address - Street 2:2ND FLOOR, STE C
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4213
Practice Address - Country:US
Practice Address - Phone:215-676-2334
Practice Address - Fax:215-676-2366
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432380207R00000X, 207RS0012X, 207RB0002X
NY259009207RS0012X
NJ25MA08590300207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3320805000OtherPERSONAL CHOICE
PATU2003676OtherBLUE SHIELD
PA19777OtherBRAVO
PA3320805000OtherKEYSTONE HEALTH PLAN EAST
PA3320805000OtherKEYSTONE HEALTH PLAN EAST