Provider Demographics
NPI:1093047664
Name:PALLIMALLI, SAI LAKSHMI (MD)
Entity Type:Individual
Prefix:
First Name:SAI
Middle Name:LAKSHMI
Last Name:PALLIMALLI
Suffix:
Gender:F
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:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-0647
Mailing Address - Country:US
Mailing Address - Phone:910-483-7337
Mailing Address - Fax:910-483-0648
Practice Address - Street 1:2620 E 7TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-4381
Practice Address - Country:US
Practice Address - Phone:704-332-7141
Practice Address - Fax:704-342-3324
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201401605208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1093047664Medicaid
NC13477037OtherPHCS/MULTIPLAN
NC260610OtherMEDCOST
NC5881053OtherUNITED HEALTHCARE
NC6035671OtherCIGNA/GREATWEST
NC19GJVOtherBCBS OF NC
NC1093047664OtherHUMANA
NC9545505OtherAETNA
NCFH1101985OtherFIRST CAROLINA CARE