Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 37492 | SC |
N | 2081P2900X | Pain Medicine | E-6621 | AR |
N | 2081P2900X | Pain Medicine | N5272 | TX |
NPI | 1013170646 |
---|---|
Provider Name | Dr. Pranitha Reddy Nallu |
First Address | Belfast, ME 04915-4473 |
Second Address | Columbia, SC 29203-6882 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2008 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
374927 | (05) | SC |