Provider Demographics
NPI:1467420919
Name:NALLURI, ANIL CHOUDARY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:CHOUDARY
Last Name:NALLURI
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 1:5500 MARKET ST
Mailing Address - Street 2:SUITE 128
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2601
Mailing Address - Country:US
Mailing Address - Phone:330-783-1147
Mailing Address - Fax:330-783-3238
Practice Address - Street 1:5500 MARKET ST
Practice Address - Street 2:SUITE 128
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-2601
Practice Address - Country:US
Practice Address - Phone:330-783-1147
Practice Address - Fax:330-783-3238
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-040657174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0356127Medicaid
PA000098641Medicaid
OH0356127Medicaid
PA000098641Medicaid