Provider Demographics
NPI:1013268077
Name:MUKKAMALLA, SHIVA KUMAR REDDY (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:SHIVA KUMAR
Middle Name:REDDY
Last Name:MUKKAMALLA
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
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Mailing Address - Street 1:IRMC CANCER CENTER 850 HOSPITAL ROAD
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701
Mailing Address - Country:US
Mailing Address - Phone:724-349-9444
Mailing Address - Fax:
Practice Address - Street 1:IRMC CANCER CENTER 850 HOSPITAL ROAD FIRST FLOOR
Practice Address - Street 2:SUITE 1300
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701
Practice Address - Country:US
Practice Address - Phone:724-349-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-30
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
NMMD2017-0778207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program