Provider Demographics
NPI:1124109855
Name:THUMMALAPALLI, MOHAN KUMAR (MD)
Entity type:Individual
Prefix:
First Name:MOHAN
Middle Name:KUMAR
Last Name:THUMMALAPALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MILFORD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6953
Mailing Address - Country:US
Mailing Address - Phone:410-543-1616
Mailing Address - Fax:410-543-8497
Practice Address - Street 1:106 MILFORD ST STE 201
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6959
Practice Address - Country:US
Practice Address - Phone:410-543-1616
Practice Address - Fax:410-543-8497
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064884208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
309269OtherANTHEM PRINCESS ANNE
309272OtherANTHEM POCOMOKE
111920574OtherTRICARE STANDARD
521860379OtherGREAT WEST
521860379OtherCOVENTRY
521860379OtherINFORMED
E1540045OtherCAREFIRST BLUE CHOICE
054635OtherJHHC
119591300OtherMD PHYSICIANS CARE
MD119591300Medicaid
2175061OtherMAMSI
309273OtherANTHEM SALISBURY
521860379OtherHUMANA
MD119591300Medicaid
MDS118P665Medicare PIN