Provider Demographics
NPI:1841552338
Name:RALLA, DEEPIKA REDDY (MD)
Entity type:Individual
Prefix:
First Name:DEEPIKA
Middle Name:REDDY
Last Name:RALLA
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 1:9552 ROCHEL DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-3854
Mailing Address - Country:US
Mailing Address - Phone:860-986-4098
Mailing Address - Fax:507-607-8545
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:860-986-4098
Practice Address - Fax:507-607-8545
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.206394207R00000X, 207RH0000X
390200000X
LAMD12345207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program