Provider Demographics
NPI:1306981964
Name:VEERABATHINI, MUKUNDAM NMI (MD)
Entity type:Individual
Prefix:DR
First Name:MUKUNDAM
Middle Name:NMI
Last Name:VEERABATHINI
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 1:3500 E COLLEGE AVE
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7569
Mailing Address - Country:US
Mailing Address - Phone:814-355-6782
Mailing Address - Fax:814-355-6985
Practice Address - Street 1:3500 E COLLEGE AVE
Practice Address - Street 2:SUITE 1200
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7569
Practice Address - Country:US
Practice Address - Phone:814-355-6782
Practice Address - Fax:814-355-6985
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072878-L2084P0804X
PAMD072878L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1836754Medicaid
PAVE10411733OtherHIGHMARK
PAVE10411733OtherHIGHMARK
PA47056Medicare ID - Type Unspecified