Provider Demographics
NPI:1477565174
Name:NERALLA, SRIDHAR (DO)
Entity Type:Individual
Prefix:
First Name:SRIDHAR
Middle Name:
Last Name:NERALLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BOULDERS PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5545
Mailing Address - Country:US
Mailing Address - Phone:804-320-4243
Mailing Address - Fax:804-282-1486
Practice Address - Street 1:6600 W BROAD ST STE 300
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1709
Practice Address - Country:US
Practice Address - Phone:804-320-4243
Practice Address - Fax:804-622-0552
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201778207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA315761OtherSOUTHERN HEALTH
VA3774667OtherAETNA HMO
VA7176222OtherMAMSI/ALLIANCE
VAP00244232OtherMEDICARE RAILROAD
VA180696OtherANTHEM
VA010168431Medicaid
VA7889658OtherAETNA NON-HMO
VA6015445OtherCIGNA
VA180696OtherHEALTHKEEPERS
VA57711OtherSOUTHERN HEALTH CARENET
VA011694P13Medicare PIN
VA7889658OtherAETNA NON-HMO