Provider Demographics
NPI:1780866046
Name:SHYAM YALLAPRAGADA MD, F.C.C.P.,P.A.
Entity Type:Organization
Organization Name:SHYAM YALLAPRAGADA MD, F.C.C.P.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:YALLAPRAGADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-572-4774
Mailing Address - Street 1:2811 TRICOM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9172
Mailing Address - Country:US
Mailing Address - Phone:843-572-4774
Mailing Address - Fax:843-572-2508
Practice Address - Street 1:2811 TRICOM ST
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9172
Practice Address - Country:US
Practice Address - Phone:843-572-4774
Practice Address - Fax:843-572-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9767207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1033Medicaid
SC7799Medicare PIN
SCD90756Medicare UPIN