Provider Demographics
NPI:1356654305
Name:TANGIRALA, NAGARAMAKRISHNA (MD)
Entity Type:Individual
Prefix:
First Name:NAGARAMAKRISHNA
Middle Name:
Last Name:TANGIRALA
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 1:1555 LONG POND ROAD
Mailing Address - Street 2:DEPARTMENT OF MEDICINE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-723-7870
Mailing Address - Fax:585-723-7871
Practice Address - Street 1:1555 LONG POND ROAD
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626
Practice Address - Country:US
Practice Address - Phone:585-723-7870
Practice Address - Fax:585-723-7871
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292857208M00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100254020Medicaid
KY7100254020Medicaid