Provider Demographics
NPI:1891921524
Name:CHALLAPALLI SRI, RAMA (MD)
Entity Type:Individual
Prefix:
First Name:RAMA
Middle Name:
Last Name:CHALLAPALLI SRI
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:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-3649
Mailing Address - Fax:417-347-9106
Practice Address - Street 1:932 E 34TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3932
Practice Address - Country:US
Practice Address - Phone:417-347-8310
Practice Address - Fax:417-347-8314
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT194414207R00000X
NH16966207RN0300X
MA261829207RN0300X
MO2017031969208M00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110103452AMedicaid
MAS400217548Medicare PIN
MA110103452AMedicaid