Provider Demographics
NPI:1689844607
Name:MITHIPATI, VANILAKSHMI (MD)
Entity Type:Individual
Prefix:
First Name:VANILAKSHMI
Middle Name:
Last Name:MITHIPATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993 BRODHEAD RD
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2331
Mailing Address - Country:US
Mailing Address - Phone:412-264-1918
Mailing Address - Fax:412-264-9114
Practice Address - Street 1:993 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-2331
Practice Address - Country:US
Practice Address - Phone:412-264-1918
Practice Address - Fax:412-264-9114
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT186984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine