Provider Demographics
NPI:1982776142
Name:KORLIPARA, ANJANAYA PRASAD RAO (MD)
Entity type:Individual
Prefix:DR
First Name:ANJANAYA PRASAD
Middle Name:RAO
Last Name:KORLIPARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 N LAWNWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4825
Mailing Address - Country:US
Mailing Address - Phone:772-489-5900
Mailing Address - Fax:772-489-2086
Practice Address - Street 1:1331 N LAWNWOOD CIR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4825
Practice Address - Country:US
Practice Address - Phone:772-489-5900
Practice Address - Fax:772-489-2086
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054509174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040773900Medicaid
FL08613Medicare ID - Type Unspecified
FL040773900Medicaid