Individual
DR. PRASADARAO B MUKKAMALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
UNION SQUARE, ONE MONONGALIA STREET, SUITE 3, CHARLESTON, WV 25302
(304) 344-5153
(304) 344-5184
Mailing address
UNION SQUARE, ONE MONONGALIA STREET, SUITE 3, CHARLESTON, WV 25302
(304) 344-5153
(304) 344-5184
Taxonomy
Speciality
Code
Description
License number
State
2081H0002X
Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
Primary
11880
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0113321000
—
WV
01
—
1022886
WORKERS' COMPENSATION
WV
Enumeration date
05/10/2007
Last updated
07/08/2007
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