Provider Demographics
NPI:1205099330
Name:ANIL CHOUDARY NALLURI MD INC
Entity type:Organization
Organization Name:ANIL CHOUDARY NALLURI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:CHOUDARY
Authorized Official - Last Name:NALLURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-783-1147
Mailing Address - Street 1:5500 MARKET ST
Mailing Address - Street 2:STE 128
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
Mailing Address - Country:US
Mailing Address - Phone:330-783-1147
Mailing Address - Fax:330-783-3238
Practice Address - Street 1:5500 MARKET ST
Practice Address - Street 2:STE 128
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512
Practice Address - Country:US
Practice Address - Phone:330-783-1147
Practice Address - Fax:330-783-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040657174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0356127Medicaid
OH0356127Medicaid
OHA77453Medicare UPIN