Provider Demographics
NPI:1669965232
Name:NELLURI, SRUTHI (MD)
Entity type:Individual
Prefix:MS
First Name:SRUTHI
Middle Name:
Last Name:NELLURI
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 1:100 N HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-2421
Mailing Address - Country:US
Mailing Address - Phone:717-218-6670
Mailing Address - Fax:
Practice Address - Street 1:100 N HANOVER ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-2421
Practice Address - Country:US
Practice Address - Phone:717-218-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2023-12-12
Deactivation Date:2019-01-25
Deactivation Code:
Reactivation Date:2019-02-06
Provider Licenses
StateLicense IDTaxonomies
PAMT215391390200000X
PAMD480233207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program