Provider Demographics
NPI:1508945338
Name:TUMULURI, VIDYASAGAR SARMA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIDYASAGAR
Middle Name:SARMA
Last Name:TUMULURI
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 1:7855 S EMERSON AVE
Mailing Address - Street 2:SUITE # N
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8668
Mailing Address - Country:US
Mailing Address - Phone:317-859-3090
Mailing Address - Fax:317-859-3092
Practice Address - Street 1:7855 S EMERSON AVE
Practice Address - Street 2:SUITE # N
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8668
Practice Address - Country:US
Practice Address - Phone:317-859-3090
Practice Address - Fax:317-859-3092
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026589A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN400000632OtherRR MEDICARE
IN000000083652OtherANTHEM BCBS
IN100059810AMedicaid
IN100059810AMedicaid
INF18524Medicare UPIN