Provider Demographics
NPI:1164530275
Name:NALLU, ANITHA (MD)
Entity Type:Individual
Prefix:
First Name:ANITHA
Middle Name:
Last Name:NALLU
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 1:5205 CHAIRMANS CT STE 100
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-2916
Mailing Address - Country:US
Mailing Address - Phone:301-696-0012
Mailing Address - Fax:301-696-0016
Practice Address - Street 1:5205 CHAIRMANS CT STE 100
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-2916
Practice Address - Country:US
Practice Address - Phone:301-696-0012
Practice Address - Fax:301-696-0016
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240273207R00000X
DCMD036252207R00000X
MDD0067325207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine