Provider Demographics
NPI:1215999362
Name:KATAPADI, KANCHANMALA (MD, INTERNAL MEDICIN)
Entity type:Individual
Prefix:
First Name:KANCHANMALA
Middle Name:
Last Name:KATAPADI
Suffix:
Gender:F
Credentials:MD, INTERNAL MEDICIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 7TH AVENUE GROUND FLOOR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215
Mailing Address - Country:US
Mailing Address - Phone:718-832-1964
Mailing Address - Fax:718-832-0526
Practice Address - Street 1:459 7TH AVENUE GROUND FLOOR
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-832-1964
Practice Address - Fax:718-832-0526
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204043173000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01816875Medicaid
NY01816875Medicaid
G45785Medicare UPIN