Provider Demographics
NPI:1376552745
Name:THUMMALA, ANURADHA R (MD)
Entity type:Individual
Prefix:
First Name:ANURADHA
Middle Name:R
Last Name:THUMMALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N STEPHANIE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6692
Mailing Address - Country:US
Mailing Address - Phone:702-952-3350
Mailing Address - Fax:702-952-3365
Practice Address - Street 1:7445 PEAK DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9011
Practice Address - Country:US
Practice Address - Phone:702-952-2140
Practice Address - Fax:702-952-2147
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11702207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509678Medicaid
NVP00340823OtherRAILROAD MEDICARE
NV102023Medicare PIN
NV100509678Medicaid