Provider Demographics
NPI:1942476783
Name:JALLI, SIREESHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SIREESHA
Middle Name:
Last Name:JALLI
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 1:2401 RESEARCH BLVD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3215
Mailing Address - Country:US
Mailing Address - Phone:301-686-8554
Mailing Address - Fax:
Practice Address - Street 1:2401 RESEARCH BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3215
Practice Address - Country:US
Practice Address - Phone:301-686-8554
Practice Address - Fax:301-686-8602
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0068080207R00000X, 207RH0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC483289Medicare PIN