Provider Demographics
NPI:1912137365
Name:ALLU, SRIDEVI (MD)
Entity Type:Individual
Prefix:
First Name:SRIDEVI
Middle Name:
Last Name:ALLU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SRIDEVI
Other - Middle Name:
Other - Last Name:MASAVARAPU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 18563
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-8563
Mailing Address - Country:US
Mailing Address - Phone:919-782-1806
Mailing Address - Fax:919-784-8102
Practice Address - Street 1:3200 BLUE RIDGE RD STE 210
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8087
Practice Address - Country:US
Practice Address - Phone:919-781-9979
Practice Address - Fax:919-781-0124
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-01340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5920870Medicaid
NCNC7706AMedicare PIN
NC5920870Medicaid