Provider Demographics
NPI:1952308959
Name:CHAGARLAMUDI, ANIL KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:KUMAR
Last Name:CHAGARLAMUDI
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 4176
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-4176
Mailing Address - Country:US
Mailing Address - Phone:985-876-0300
Mailing Address - Fax:985-872-0317
Practice Address - Street 1:225 DUNN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4413
Practice Address - Country:US
Practice Address - Phone:985-876-0300
Practice Address - Fax:985-872-0317
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15183R207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1159409Medicaid
LAP00078777OtherRR MEDCIARE
LA4F308Medicare PIN
LAP00078777OtherRR MEDCIARE
LA5U3936833Medicare UPIN