Provider Demographics
NPI:1558450718
Name:TARIGOPULA, CHOUDARY V (MD)
Entity Type:Individual
Prefix:DR
First Name:CHOUDARY
Middle Name:V
Last Name:TARIGOPULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:222 S WOODS MILL RD STE 450S
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-205-2733
Mailing Address - Fax:314-434-6476
Practice Address - Street 1:222 S WOODS MILL RD STE 450S
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:314-205-2733
Practice Address - Fax:314-434-6476
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103774207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00080017OtherRAILROAD
MO000095008Medicare PIN
P00080017Medicare PIN
MOH25210Medicare UPIN