Provider Demographics
NPI:1982600227
Name:NALLURI, PRASADA RAO (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASADA
Middle Name:RAO
Last Name:NALLURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 9TH AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-2703
Mailing Address - Country:US
Mailing Address - Phone:409-982-5000
Mailing Address - Fax:
Practice Address - Street 1:2001 9TH AVE
Practice Address - Street 2:STE 201
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-2703
Practice Address - Country:US
Practice Address - Phone:409-982-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2019-08-08
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
TXK8371207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB144108Medicare PIN