Provider Demographics
NPI:1871718486
Name:BELLAMKONDA, PALLAVI (MD)
Entity type:Individual
Prefix:DR
First Name:PALLAVI
Middle Name:
Last Name:BELLAMKONDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3030 N CENTRAL AVE STE 1001
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2716
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:500 W THOMAS RD STE 480
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4239
Practice Address - Country:US
Practice Address - Phone:602-406-1150
Practice Address - Fax:602-406-1159
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ56422207RC0000X
NE26233207RC0000X
IAMD-43846207RC0000X
MO2009021711207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098684356Medicare PIN