Provider Demographics
NPI:1639338585
Name:YALLAPRAGADA, ANIL VENKATA SESHU (MD)
Entity type:Individual
Prefix:DR
First Name:ANIL
Middle Name:VENKATA SESHU
Last Name:YALLAPRAGADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:400 ASSOCIATION DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1298
Mailing Address - Country:US
Mailing Address - Phone:304-388-1724
Mailing Address - Fax:304-388-1721
Practice Address - Street 1:9330 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9104
Practice Address - Country:US
Practice Address - Phone:438-474-4372
Practice Address - Fax:843-847-5187
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2023-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA01012696192084V0102X, 2084N0400X
WV325502084V0102X, 2084N0400X
390200000X
SC364372084V0102X, 2084N0400X
NY3073572084N0400X
CAA1173332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1639338585Medicaid
SC364377Medicaid
SCSC24109482Medicare PIN
CAGC585ZMedicare PIN
CA1639338585Medicaid