Provider Demographics
NPI:1457560963
Name:MAHIJA KOTTAPALLI MD PLLC
Entity Type:Organization
Organization Name:MAHIJA KOTTAPALLI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHIJA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTTAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-757-4032
Mailing Address - Street 1:1401 HOSPITAL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9237
Mailing Address - Country:US
Mailing Address - Phone:304-757-4032
Mailing Address - Fax:304-757-3026
Practice Address - Street 1:1401 HOSPITAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9237
Practice Address - Country:US
Practice Address - Phone:304-757-4032
Practice Address - Fax:304-757-3026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV211832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1366511271OtherINDIVIDUAL NPI
WV3810000361Medicaid
WV3810000361Medicaid
1366511271OtherINDIVIDUAL NPI