Provider Demographics
NPI:1245437854
Name:KALA, PADMA (MD)
Entity type:Individual
Prefix:
First Name:PADMA
Middle Name:
Last Name:KALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PADMASREE
Other - Middle Name:
Other - Last Name:KOTIKALAPUDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2710 BELLFOREST CT
Mailing Address - Street 2:# 409
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-7331
Mailing Address - Country:US
Mailing Address - Phone:201-264-9475
Mailing Address - Fax:
Practice Address - Street 1:HUNTER HOLMES MCGUIRE MEDICAL CTR
Practice Address - Street 2:1201 BROAD ROCK BOULEVARD
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012408372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH67634Medicare UPIN