Provider Demographics
NPI:1972724086
Name:MAMILLAPALLI, NARAYANA SWAMY (MD)
Entity Type:Individual
Prefix:
First Name:NARAYANA
Middle Name:SWAMY
Last Name:MAMILLAPALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1845 PRECINCT LINE RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3179
Mailing Address - Country:US
Mailing Address - Phone:817-632-5803
Mailing Address - Fax:
Practice Address - Street 1:1845 PRECINCT LINE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054
Practice Address - Country:US
Practice Address - Phone:817-632-5803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP93952085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology