Provider Demographics
NPI:1649367236
Name:PALLERLA, SWAPNA REDDY (MD)
Entity type:Individual
Prefix:
First Name:SWAPNA
Middle Name:REDDY
Last Name:PALLERLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2200 PHILADELPHIA DR
Mailing Address - Street 2:STE 441
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-1840
Mailing Address - Country:US
Mailing Address - Phone:937-734-2230
Mailing Address - Fax:937-567-4186
Practice Address - Street 1:2200 PHILADELPHIA DR
Practice Address - Street 2:STE 441
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1840
Practice Address - Country:US
Practice Address - Phone:937-734-2230
Practice Address - Fax:937-567-4186
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.088355207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2691449Medicaid
OH2691449Medicaid