Provider Demographics
NPI:1114772035
Name:KOTA, SRI DHEERAJA (MD)
Entity type:Individual
Prefix:
First Name:SRI DHEERAJA
Middle Name:
Last Name:KOTA
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 1:5 MOBILE INFIRMARY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607
Mailing Address - Country:US
Mailing Address - Phone:251-435-7151
Mailing Address - Fax:
Practice Address - Street 1:5 MOBILE INFIRMARY CIRCLE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607
Practice Address - Country:US
Practice Address - Phone:251-435-7151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2025-01-30
Deactivation Date:2024-12-23
Deactivation Code:
Reactivation Date:2025-01-30
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program