Provider Demographics
NPI:1851646517
Name:PAGADALA, BHUVANESHWAR (MD)
Entity Type:Individual
Prefix:DR
First Name:BHUVANESHWAR
Middle Name:
Last Name:PAGADALA
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 1:3164 BERRY LN
Mailing Address - Street 2:113
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6329
Mailing Address - Country:US
Mailing Address - Phone:540-293-7017
Mailing Address - Fax:
Practice Address - Street 1:3164 BERRY LN APT 113
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6329
Practice Address - Country:US
Practice Address - Phone:540-293-7017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1160250972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry