Provider Demographics
NPI:1255504098
Name:PAVULURI, VEERA (MD)
Entity Type:Individual
Prefix:
First Name:VEERA
Middle Name:
Last Name:PAVULURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 MADISON NORTH DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-7626
Mailing Address - Country:US
Mailing Address - Phone:973-204-9230
Mailing Address - Fax:
Practice Address - Street 1:132 MADISON NORTH DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31220-7626
Practice Address - Country:US
Practice Address - Phone:973-204-9230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091402207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1034159OtherMCLAREN
MI01012510OtherHEALTHPLUS COMMERCIAL
MI1105910542OtherBCBSM
MIP00678941OtherRAILROAD MEDICARE
MI1037015OtherMCLAREN
MI200000017905OtherPHP COMMERCIAL
MI1037015OtherMCLAREN
MI200000017905OtherPHP COMMERCIAL