Provider Demographics
NPI:1760216485
Name:KANAMARLAPUDI, HAASYA
Entity type:Individual
Prefix:
First Name:HAASYA
Middle Name:
Last Name:KANAMARLAPUDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4847 FLOSSMOOR PL APT 204
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-6107
Mailing Address - Country:US
Mailing Address - Phone:609-379-1213
Mailing Address - Fax:
Practice Address - Street 1:284 MERRIMAC CT
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4133
Practice Address - Country:US
Practice Address - Phone:410-535-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist