Individual
DR. PRASHANTH PODARALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 MEDICAL DR, HANNIBAL, MO 63401-6877
(573) 231-3798
(573) 231-3827
Mailing address
100 MEDICAL DR, HANNIBAL, MO 63401-6877
(573) 231-3798
(573) 231-3827
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2006017617
MO
207RN0300X
Nephrology Physician
Primary
2006017617
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
137720019
MEDICARE
MO
05
—
1730226952
—
MO
Enumeration date
01/30/2007
Last updated
03/03/2021
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