Provider Demographics
NPI:1912364563
Name:MULPUR, SIRISH KANT SURESH (MD)
Entity type:Individual
Prefix:DR
First Name:SIRISH KANT
Middle Name:SURESH
Last Name:MULPUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SIRISH
Other - Middle Name:
Other - Last Name:MULPUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SIRISH MULPURA, MD
Mailing Address - Street 1:11815 FOUNTAIN WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4448
Mailing Address - Country:US
Mailing Address - Phone:757-734-5534
Mailing Address - Fax:757-734-5534
Practice Address - Street 1:11815 FOUNTAIN WAY STE 300
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4448
Practice Address - Country:US
Practice Address - Phone:757-734-5534
Practice Address - Fax:757-734-5534
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1310412084P0800X
TN581822084P0800X
VA01012672222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry