Individual
AJAY K. KOTTAPALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5287
(740) 446-5854
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5287
(740) 446-5854
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
18873
WV
207R00000X
Internal Medicine Physician
Primary
35-07-4335
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000185257
UNISON MEDICAID
OH
01
—
000000198554
ANTHEM BCBS
—
01
—
000357167
MOUNTAIN STATE BCBS
—
05
—
0080104000
—
WV
01
—
110192508
RR MEDICARE
—
01
—
2088753
MOLINA MEDICAID
OH
05
—
2088753
—
OH
01
—
310917085049
OH MEDICAID CARESOURCE
OH
Enumeration date
05/31/2006
Last updated
01/21/2021
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