Provider Demographics
NPI:1609809920
Name:KODALI, VALLI P (MD)
Entity Type:Individual
Prefix:DR
First Name:VALLI
Middle Name:P
Last Name:KODALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7560 CARPENTER FIRE STATION RD STE 303
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-9637
Mailing Address - Country:US
Mailing Address - Phone:919-650-6461
Mailing Address - Fax:919-650-6422
Practice Address - Street 1:7560 CARPENTER FIRE STATION RD STE 303
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-9637
Practice Address - Country:US
Practice Address - Phone:919-650-6461
Practice Address - Fax:919-650-6422
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35010207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0329849-001OtherCIGNA
49976OtherBCBS
NC8949976Medicaid
NC8949976Medicaid
49976OtherBCBS