Provider Demographics
NPI:1497722524
Name:NUTHI, USHA KIRAN (MD)
Entity Type:Individual
Prefix:
First Name:USHA
Middle Name:KIRAN
Last Name:NUTHI
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:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:775-356-4888
Mailing Address - Fax:
Practice Address - Street 1:2385 E PRATER WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-9629
Practice Address - Country:US
Practice Address - Phone:775-356-4888
Practice Address - Fax:775-356-4890
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000228412084N0400X
NV155932084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1497722524Medicaid
ALH04896Medicare UPIN
ALH04896Medicare UPIN