Provider Demographics
NPI:1558350603
Name:MANGIPUDI, MURTHY VS (MD)
Entity Type:Individual
Prefix:MR
First Name:MURTHY
Middle Name:VS
Last Name:MANGIPUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4234 WEBER ROAD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-3603
Mailing Address - Country:US
Mailing Address - Phone:361-857-2090
Mailing Address - Fax:361-814-6302
Practice Address - Street 1:4234 WEBER ROAD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-3603
Practice Address - Country:US
Practice Address - Phone:361-857-2090
Practice Address - Fax:361-814-6302
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ75712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139860409Medicaid
D02592Medicare UPIN
TX85W712Medicare PIN