Provider Demographics
NPI:1467470740
Name:TALLAPUREDDY, SATYARANI (MD)
Entity Type:Individual
Prefix:
First Name:SATYARANI
Middle Name:
Last Name:TALLAPUREDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 WOODLAND ST FL 1
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1230
Mailing Address - Country:US
Mailing Address - Phone:860-714-7362
Mailing Address - Fax:860-714-8140
Practice Address - Street 1:43 WOODLAND ST
Practice Address - Street 2:SUITE 120
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2363
Practice Address - Country:US
Practice Address - Phone:860-471-8030
Practice Address - Fax:860-244-9143
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042339207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001423392Medicaid
CT001423392Medicaid