Provider Demographics
NPI:1952508301
Name:KOPPOLU, PALLAVI REDDY (MD)
Entity Type:Individual
Prefix:
First Name:PALLAVI
Middle Name:REDDY
Last Name:KOPPOLU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PALLAVI
Other - Middle Name:REDDY
Other - Last Name:MUNAGALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2800 E AJO WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-6204
Mailing Address - Country:US
Mailing Address - Phone:520-874-4502
Mailing Address - Fax:520-874-4510
Practice Address - Street 1:2800 E AJO WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-6204
Practice Address - Country:US
Practice Address - Phone:520-874-4502
Practice Address - Fax:520-874-4510
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR71692207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine