Provider Demographics
NPI:1962404343
Name:KOTTAPALLY, SRINIVAS (MD)
Entity type:Individual
Prefix:
First Name:SRINIVAS
Middle Name:
Last Name:KOTTAPALLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SRI
Other - Middle Name:
Other - Last Name:KOTTAPALLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:845 ASHTON CT
Mailing Address - Street 2:
Mailing Address - City:NORTH HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-3999
Mailing Address - Country:US
Mailing Address - Phone:814-603-3676
Mailing Address - Fax:
Practice Address - Street 1:51 BREWER DR
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8400
Practice Address - Country:US
Practice Address - Phone:724-437-2503
Practice Address - Fax:724-437-8846
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039369L2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA470927OtherHIGHMARK BC/BS
PA470927OtherHIGHMARK BC/BS
B42118Medicare UPIN