Provider Demographics
NPI:1508853839
Name:PEMMARAJU, SESHAGIRIRAO (MD)
Entity Type:Individual
Prefix:
First Name:SESHAGIRIRAO
Middle Name:
Last Name:PEMMARAJU
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 1:801 CENTRAL AVE STE 32
Mailing Address - Street 2:PO BOX 846
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71902
Mailing Address - Country:US
Mailing Address - Phone:501-624-4547
Mailing Address - Fax:501-624-5697
Practice Address - Street 1:300 WERNER ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6406
Practice Address - Country:US
Practice Address - Phone:501-622-1048
Practice Address - Fax:501-622-1847
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2634207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR54021Medicare ID - Type Unspecified
B90474Medicare UPIN