Provider Demographics
NPI:1053360008
Name:ALLURI, JAGGA RAO (MD)
Entity type:Individual
Prefix:
First Name:JAGGA
Middle Name:RAO
Last Name:ALLURI
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 1:11050 71ST RD
Mailing Address - Street 2:STE 1B
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4969
Mailing Address - Country:US
Mailing Address - Phone:718-268-1458
Mailing Address - Fax:718-268-1471
Practice Address - Street 1:11050 71ST RD
Practice Address - Street 2:STE 1B
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4969
Practice Address - Country:US
Practice Address - Phone:718-268-1458
Practice Address - Fax:718-268-1471
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197909174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02110007Medicaid
NY113592494OtherUNITED HEALTH CARE
NY3099573OtherGHI
NY113592494Other1199
NYP861424OtherOXFORD
NY204814BOtherMAGNA CARE
NY5898587OtherAETNA
NY3C0106OtherACS HEALTH NET
NY73Y713OtherEMPIRE
NY113592494OtherAARP
NY02110007Medicaid