Provider Demographics
NPI:1811061542
Name:VUPPALA, MURTY S
Entity type:Individual
Prefix:MR
First Name:MURTY
Middle Name:S
Last Name:VUPPALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 YORK ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3031
Mailing Address - Country:US
Mailing Address - Phone:440-888-1500
Mailing Address - Fax:440-888-5809
Practice Address - Street 1:6363 YORK ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3031
Practice Address - Country:US
Practice Address - Phone:440-888-1500
Practice Address - Fax:440-888-5809
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042888208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics