Provider Demographics
NPI:1720511272
Name:NATARAJ, KRUPA REVANNA (MD)
Entity Type:Individual
Prefix:
First Name:KRUPA
Middle Name:REVANNA
Last Name:NATARAJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRUPA
Other - Middle Name:
Other - Last Name:NATARAJ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 70567
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-1707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:178 MAPLE CT
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-3156
Practice Address - Country:US
Practice Address - Phone:301-836-1346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1642672084P0800X
MDD914082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry