Provider Demographics
NPI:1669642799
Name:TALLAPUREDDY, SAMEERA (MD)
Entity Type:Individual
Prefix:
First Name:SAMEERA
Middle Name:
Last Name:TALLAPUREDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAMEERA
Other - Middle Name:
Other - Last Name:LAKIREDDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2110 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2313
Mailing Address - Country:US
Mailing Address - Phone:860-258-3470
Mailing Address - Fax:860-571-6800
Practice Address - Street 1:100 RETREAT AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2528
Practice Address - Country:US
Practice Address - Phone:860-547-1278
Practice Address - Fax:860-547-1301
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT048964207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT048964OtherLICENSE