Provider Demographics
NPI:1710900790
Name:KRUPADEV, HITNEBAGILU L (MD LLC)
Entity Type:Individual
Prefix:
First Name:HITNEBAGILU
Middle Name:L
Last Name:KRUPADEV
Suffix:
Gender:M
Credentials:MD LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750
Mailing Address - Country:US
Mailing Address - Phone:740-373-5119
Mailing Address - Fax:
Practice Address - Street 1:408 THIRD STREET
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750
Practice Address - Country:US
Practice Address - Phone:740-373-5119
Practice Address - Fax:740-373-7090
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042059K207R00000X
OH3504259207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0445923Medicaid
0515682Medicare ID - Type Unspecified
OH0445923Medicaid
A80403Medicare UPIN