Provider Demographics
NPI:1336358233
Name:YARLAGADDA, RAJKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:RAJKUMAR
Middle Name:
Last Name:YARLAGADDA
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 1:16929 FRANCES ST STE 204
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4683
Mailing Address - Country:US
Mailing Address - Phone:402-758-5233
Mailing Address - Fax:402-758-5270
Practice Address - Street 1:16929 FRANCES ST STE 204
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4683
Practice Address - Country:US
Practice Address - Phone:402-758-5233
Practice Address - Fax:402-758-5270
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI557582085R0202X
IA402722085R0202X
SD83762085R0202X
NE267692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1336358233Medicaid
NE1336358233Medicaid
IAI14677003Medicare PIN
NE1336358233Medicaid