Provider Demographics
NPI:1215910336
Name:MUNAVALLI, GIRISH SOMASHEKHAR (MD)
Entity type:Individual
Prefix:DR
First Name:GIRISH
Middle Name:SOMASHEKHAR
Last Name:MUNAVALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1918 RANDOLPH RD
Mailing Address - Street 2:SUITE 550
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1100
Mailing Address - Country:US
Mailing Address - Phone:704-375-6766
Mailing Address - Fax:410-666-3981
Practice Address - Street 1:1918 RANDOLPH RD
Practice Address - Street 2:SUITE 550
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1100
Practice Address - Country:US
Practice Address - Phone:704-375-6766
Practice Address - Fax:704-332-6552
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200400240207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH87182Medicare UPIN