Provider Demographics
NPI:1649385733
Name:KOTHAPALLY, JAGAN (MD)
Entity Type:Individual
Prefix:
First Name:JAGAN
Middle Name:
Last Name:KOTHAPALLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2140 KINGSLEY AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5129
Mailing Address - Country:US
Mailing Address - Phone:904-529-5252
Mailing Address - Fax:904-529-5253
Practice Address - Street 1:2091 LANGHORNE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501
Practice Address - Country:US
Practice Address - Phone:434-947-3954
Practice Address - Fax:434-947-5944
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-08-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME115829207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology