Provider Demographics
NPI:1538191069
Name:YARLAGADDA, SURESH K (MD)
Entity type:Individual
Prefix:
First Name:SURESH
Middle Name:K
Last Name:YARLAGADDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:275 SANDWICH ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2183
Mailing Address - Country:US
Mailing Address - Phone:508-746-2000
Mailing Address - Fax:508-830-2502
Practice Address - Street 1:275 SANDWICH ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2183
Practice Address - Country:US
Practice Address - Phone:508-746-2000
Practice Address - Fax:508-830-2502
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA227997207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000033955OtherBMC HEALTHNET PLAN
MA2121212Medicaid
MA494924OtherTUFTS HEALTH PLAN
MAAA66571OtherHARVARD PILGRIM HEALTHCAR
MAJ40365OtherBCBSMA
MAJ40365OtherBCBSMA
MAAA66571OtherHARVARD PILGRIM HEALTHCAR