Provider Demographics
NPI:1992901433
Name:KATTUPALLI, GERONAMI PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:GERONAMI
Middle Name:PAUL
Last Name:KATTUPALLI
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 1:175 BARRENS CT STE 100
Mailing Address - Street 2:
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870-7043
Mailing Address - Country:US
Mailing Address - Phone:814-777-1071
Mailing Address - Fax:814-424-2202
Practice Address - Street 1:341 SCIENCE PARK RD STE 202
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2287
Practice Address - Country:US
Practice Address - Phone:814-424-2095
Practice Address - Fax:814-424-2202
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT189831207Q00000X
PAMD440359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARES0000Medicare UPIN