Provider Demographics
NPI:1497734842
Name:KOTHAPALLI, NAGASAYANA RAO (MD)
Entity Type:Individual
Prefix:
First Name:NAGASAYANA
Middle Name:RAO
Last Name:KOTHAPALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAO
Other - Middle Name:N
Other - Last Name:KOTHAPALLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344
Mailing Address - Country:US
Mailing Address - Phone:919-663-3161
Mailing Address - Fax:919-663-2212
Practice Address - Street 1:315 EAST 3RD STREET
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344
Practice Address - Country:US
Practice Address - Phone:919-663-3161
Practice Address - Fax:919-663-2212
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24169208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8950236Medicaid
50236OtherBCBS
NC8950236Medicaid
50236OtherBCBS