Provider Demographics
NPI:1144335738
Name:CHANNAPATI, THIPPESWAMY T (MD)
Entity type:Individual
Prefix:MR
First Name:THIPPESWAMY
Middle Name:T
Last Name:CHANNAPATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001
Mailing Address - Country:US
Mailing Address - Phone:724-282-8011
Mailing Address - Fax:724-282-3165
Practice Address - Street 1:342 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001
Practice Address - Country:US
Practice Address - Phone:724-282-8011
Practice Address - Fax:724-282-3165
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0356904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0692829Medicaid
042105Medicare PIN
PA0692829Medicaid