Provider Demographics
NPI:1689759946
Name:THOTAKURA, UMALAKSHMI KANURU (MD)
Entity Type:Individual
Prefix:
First Name:UMALAKSHMI
Middle Name:KANURU
Last Name:THOTAKURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:UMALAKSHMI
Other - Middle Name:
Other - Last Name:KANURU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 ASHLEYBROOK SQUARE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-765-6577
Mailing Address - Fax:336-768-2972
Practice Address - Street 1:125 ASHLEYBROOK SQUARE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-765-6577
Practice Address - Fax:336-768-2972
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93003432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
83341OtherBCBS OF NC
NC8983341Medicaid
83341OtherBCBS OF NC
F62718Medicare UPIN