Provider Demographics
NPI:1407878523
Name:MARELLA, PUNNAIAH (MD)
Entity Type:Individual
Prefix:
First Name:PUNNAIAH
Middle Name:
Last Name:MARELLA
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 1:9515 W CAMELBACK RD STE 114
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-1365
Mailing Address - Country:US
Mailing Address - Phone:623-777-1720
Mailing Address - Fax:623-777-1799
Practice Address - Street 1:9515 W CAMELBACK RD
Practice Address - Street 2:STE 114
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037
Practice Address - Country:US
Practice Address - Phone:623-777-1720
Practice Address - Fax:623-777-1799
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37090208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ234175Medicaid
AZZ124567Medicare PIN