Provider Demographics
NPI:1225283815
Name:POTLURU, PRAVEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAVEEN
Middle Name:
Last Name:POTLURU
Suffix:
Gender:M
Credentials:MD
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 N ROAD ST
Mailing Address - Street 2:ALBEMARLE HOSPITAL DEPT. OF ANESTHESIA
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3473
Mailing Address - Country:US
Mailing Address - Phone:252-384-4800
Mailing Address - Fax:252-384-4009
Practice Address - Street 1:1144 N ROAD ST
Practice Address - Street 2:ALBEMARLE HOSPITAL DEPT. OF ANESTHESIA
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3473
Practice Address - Country:US
Practice Address - Phone:252-384-4800
Practice Address - Fax:252-384-4009
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200801837207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology