Provider Demographics
NPI:1639168487
Name:VEERAMACHANENI, NAGARAJU (MD)
Entity Type:Individual
Prefix:
First Name:NAGARAJU
Middle Name:
Last Name:VEERAMACHANENI
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 1:5150 N 16TH ST
Mailing Address - Street 2:STE B232
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3990
Mailing Address - Country:US
Mailing Address - Phone:623-298-1744
Mailing Address - Fax:623-298-1738
Practice Address - Street 1:3115 S PRICE RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-3544
Practice Address - Country:US
Practice Address - Phone:888-488-7640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ360909Medicaid
AZBV4958899OtherDEA
AZ360909Medicaid
AZBV4958899OtherDEA