Provider Demographics
NPI:1912937897
Name:JAGARLAMUDI, ANNAPURNA (MD)
Entity Type:Individual
Prefix:
First Name:ANNAPURNA
Middle Name:
Last Name:JAGARLAMUDI
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 1:6100 HARRIS PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4101
Mailing Address - Country:US
Mailing Address - Phone:817-820-4906
Mailing Address - Fax:817-820-4815
Practice Address - Street 1:6100 HARRIS PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4101
Practice Address - Country:US
Practice Address - Phone:817-820-4906
Practice Address - Fax:817-820-4815
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.087715207R00000X
WV23403207R00000X
TXP5087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000210223OtherOH MEDICAID UNISON
OH310917085173OtherOH MEDICAID CARESOURCE
WV3810005849Medicaid
OH2687758OtherOH MEDICAID MOLINA
001875984OtherMOUNTAIN STATE BCBS
OH2687758Medicaid
P00363725OtherRR MEDICARE
OH000000210223OtherOH MEDICAID UNISON
OH310917085173OtherOH MEDICAID CARESOURCE
TX276883YKPWMedicare PIN