Provider Demographics
NPI:1942262498
Name:GURRALA, GEETHA (MD)
Entity Type:Individual
Prefix:DR
First Name:GEETHA
Middle Name:
Last Name:GURRALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 HOOSICK ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2444
Mailing Address - Country:US
Mailing Address - Phone:518-272-0232
Mailing Address - Fax:518-272-4083
Practice Address - Street 1:258 HOOSICK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2444
Practice Address - Country:US
Practice Address - Phone:518-272-0232
Practice Address - Fax:518-272-4083
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09726400207P00000X, 208000000X
NY227601-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ048999Medicaid
NY100607000130OtherFIDELIS
NY635085OtherGHI/HMO
NY7435391OtherAETNA
NY02429638Medicaid
NY116ZB1OtherEMPIRE BC