Provider Demographics
NPI:1275542649
Name:YERRA, NAGARJUNA (MD)
Entity Type:Individual
Prefix:
First Name:NAGARJUNA
Middle Name:
Last Name:YERRA
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 1:1007 GREGORY DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-6451
Mailing Address - Country:US
Mailing Address - Phone:252-535-6478
Mailing Address - Fax:252-535-6483
Practice Address - Street 1:1007 GREGORY DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-6451
Practice Address - Country:US
Practice Address - Phone:252-535-6478
Practice Address - Fax:252-535-6483
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700163207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0167JOtherBCBS
NC891068EMedicaid
F51270Medicare UPIN
2235302BMedicare ID - Type Unspecified