Provider Demographics
NPI:1114903275
Name:NASSARALLA, CLAUDIA L (MD)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:L
Last Name:NASSARALLA
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 1:508 FULTON ST
Mailing Address - Street 2:GRECC 182
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3875
Mailing Address - Country:US
Mailing Address - Phone:414-403-9612
Mailing Address - Fax:
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:GRECC 182
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:414-403-9612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47737207R00000X
WI50420207R00000X
NC2013-00587207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34918900Medicaid
MN044122800Medicaid
MN044122800Medicaid
I35675Medicare UPIN
WI10101:01545Medicare PIN
MN044122800Medicaid
WI521830Medicare Oscar/Certification
WI521805Medicare Oscar/Certification
MN110010259Medicare ID - Type Unspecified