Provider Demographics
NPI:1558315481
Name:PEDDY, KAPPA M (MD)
Entity Type:Individual
Prefix:DR
First Name:KAPPA
Middle Name:M
Last Name:PEDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1330 OAK LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2513
Mailing Address - Country:US
Mailing Address - Phone:434-847-6132
Mailing Address - Fax:434-845-4870
Practice Address - Street 1:1330 OAK LN
Practice Address - Street 2:SUITE 101
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503
Practice Address - Country:US
Practice Address - Phone:434-847-6132
Practice Address - Fax:434-845-4870
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101225823207ND0900X, 207NI0002X, 207NP0225X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA216440OtherANTHEM
VA310025OtherSOUTHERN HEALTH
VA070015463OtherMEDICARE RAILROAD
VA541667390OtherTAX ID
VA8152058OtherCIGNA
VA5901839Medicaid