Provider Demographics
NPI:1831299346
Name:GUTTI, SUJATA RAO (MD)
Entity Type:Individual
Prefix:DR
First Name:SUJATA
Middle Name:RAO
Last Name:GUTTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2158
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2158
Mailing Address - Country:US
Mailing Address - Phone:606-437-4100
Mailing Address - Fax:606-432-6009
Practice Address - Street 1:515 N BYPASS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1331
Practice Address - Country:US
Practice Address - Phone:606-437-4100
Practice Address - Fax:606-432-6009
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY327712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64327711Medicaid
WV0090727000Medicaid
WV0090727000Medicaid
KY64327711Medicaid