Provider Demographics
NPI:1720617970
Name:THOOTKUR, MOUNICA REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:MOUNICA REDDY
Middle Name:
Last Name:THOOTKUR
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 1:2017 SOUTH JEFFERSON STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014
Mailing Address - Country:US
Mailing Address - Phone:540-266-6961
Mailing Address - Fax:
Practice Address - Street 1:2017 SOUTH JEFFERSON STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014
Practice Address - Country:US
Practice Address - Phone:540-266-6961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program