Individual
SIVA PRASAD REDDY PESALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3803 EMERSON AVE, PARKERSBURG, WV 26104-1116
(304) 485-5041
(304) 485-5678
Mailing address
3803 EMERSON AVE, PARKERSBURG, WV 26104-1116
(304) 485-5041
(304) 485-5678
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
32764
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2014019434
MISSOURI TEMPORARY LICENSE
MO
Enumeration date
06/24/2014
Last updated
09/17/2023
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