Provider Demographics
NPI:1255449906
Name:NAGARAJ, HOSAHALLY (MD)
Entity type:Individual
Prefix:
First Name:HOSAHALLY
Middle Name:
Last Name:NAGARAJ
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 1:2400 S AVENUE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7170
Mailing Address - Country:US
Mailing Address - Phone:928-344-2000
Mailing Address - Fax:
Practice Address - Street 1:2400 S AVENUE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7127
Practice Address - Country:US
Practice Address - Phone:928-344-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ64842207L00000X
NY187428207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05277OtherMVP
NY01269772Medicaid
NY10001449OtherCDPHP
NY187428-8CANOtherWC
NY12G281OtherEMPIRE BS
NY2600296OtherGHI
NY5765306OtherAETNA
NY000410983001OtherBSNENY
NY10001449OtherCDPHP
NY5765306OtherAETNA