Provider Demographics
NPI:1700910288
Name:KASIBHOTLA, SUMABALA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMABALA
Middle Name:
Last Name:KASIBHOTLA
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 1:1033 W GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-3905
Mailing Address - Country:US
Mailing Address - Phone:610-539-8500
Mailing Address - Fax:610-539-0910
Practice Address - Street 1:1033 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19403-3905
Practice Address - Country:US
Practice Address - Phone:610-539-8500
Practice Address - Fax:610-539-0910
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072211L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine