Provider Demographics
NPI:1487695318
Name:THUPPAL, MADHAVAN (MD)
Entity type:Individual
Prefix:DR
First Name:MADHAVAN
Middle Name:
Last Name:THUPPAL
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 ROBB HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1700
Mailing Address - Country:US
Mailing Address - Phone:412-278-0477
Mailing Address - Fax:
Practice Address - Street 1:110 FORT COUCH RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-1030
Practice Address - Country:US
Practice Address - Phone:412-831-1223
Practice Address - Fax:412-831-1034
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-070792-L2084P0802X, 2084P0804X
PAMD070792L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA928263OtherHIGHMARK
PA0018224090003Medicaid
PA7180402OtherAETNA
PA469699OtherVALUE OPTIONS
PAH22301Medicare UPIN
PA469699OtherVALUE OPTIONS