Provider Demographics
NPI:1356757116
Name:THIRTALA, THRIPURA (MD)
Entity type:Individual
Prefix:
First Name:THRIPURA
Middle Name:
Last Name:THIRTALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25101 CHAGRIN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5694
Mailing Address - Country:US
Mailing Address - Phone:216-468-5000
Mailing Address - Fax:216-456-8128
Practice Address - Street 1:255 SPENCER RD STE 201
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2576
Practice Address - Country:US
Practice Address - Phone:636-929-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250653222084P0800X
MO20180152802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry