Provider Demographics
NPI:1861428518
Name:GOTTIMUKKALA, MARUTHI V (MD)
Entity type:Individual
Prefix:DR
First Name:MARUTHI
Middle Name:V
Last Name:GOTTIMUKKALA
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 1:844 KEMPSVILLE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3927
Mailing Address - Country:US
Mailing Address - Phone:757-261-0700
Mailing Address - Fax:
Practice Address - Street 1:844 KEMPSVILLE RD STE 204
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3927
Practice Address - Country:US
Practice Address - Phone:757-261-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041083207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherVIRGINIA PREMIER HEALTH
VA413773OtherUHC/MAMSI
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VA295590OtherANTHEM
VAPAROtherUSA MANAGED CARE
VAPAROtherCIGNA
VAPAROtherAETNA
VA10015737OtherSENTARA OPTIMA
VA1861428518Medicaid
VA187095OtherANTHEM BC/BS
VA313773OtherMAMSI
VA-001OtherTRICARE CHAMPUS
NC0604XOtherNC BC/BS
VA15848OtherOPTIMA HEALTH PLAN
NC890604XMedicaid
VAPAROtherMULTIPLAN
VA010226805Medicaid
VAPAROtherCORVEL/CORCARE
VA413773OtherUHC/MAMSI
VAPAROtherCIGNA
VA10015737OtherSENTARA OPTIMA
NC0604XOtherNC BC/BS
VA1861428518Medicaid