Provider Demographics
NPI:1861434128
Name:MUMMANENI, NAGAPRASADARAO (MD)
Entity type:Individual
Prefix:DR
First Name:NAGAPRASADARAO
Middle Name:
Last Name:MUMMANENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NAGA
Other - Middle Name:
Other - Last Name:MUMMANENI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3617 GLENHOME DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-0118
Mailing Address - Country:US
Mailing Address - Phone:248-425-8880
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:3617 GLENHOME DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-0118
Practice Address - Country:US
Practice Address - Phone:248-425-8880
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4175207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine