Provider Demographics
NPI:1497746499
Name:VELLANKI, ANU PRASAD (MD)
Entity Type:Individual
Prefix:
First Name:ANU
Middle Name:PRASAD
Last Name:VELLANKI
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:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:GRAMERCY
Mailing Address - State:LA
Mailing Address - Zip Code:70052-0419
Mailing Address - Country:US
Mailing Address - Phone:225-869-9200
Mailing Address - Fax:225-869-9241
Practice Address - Street 1:827 N PINE ST
Practice Address - Street 2:
Practice Address - City:GRAMERCY
Practice Address - State:LA
Practice Address - Zip Code:70052-3659
Practice Address - Country:US
Practice Address - Phone:225-869-9200
Practice Address - Fax:225-869-9241
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12855R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA04-01417OtherUNITED HEALTH CARE
LA1559571Medicaid
LA1448800OtherMEDICAID RURAL HEALTH
LA193870OtherMEDICARE RURAL HEALTH
LA193875OtherMEDICARE RURAL HEALTH
LA110215391OtherRAILROAD MEDICARE
LA1457621OtherMEDICAID RURAL HEALTH
LA5CE42OtherMEDICARE GROUP
LA7110052OtherAETNA
LA$$$$$$$$$AOtherBLUE CROSS
LA193870OtherMEDICARE RURAL HEALTH
LA5CE42OtherMEDICARE GROUP