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General NPI Number Information
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NPI Number | 1851489058
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Entity Type | Individual
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Provider Name | PRAMOD KESAVASWAMY NELLURI M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 4300 W 7TH ST VA HOSPITAL CAVHS
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5446
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Country | US
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Telephone | 501-257-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 35 MARCELLA DR
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City | LITTLE ROCK
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State | AR
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Zip | 72223-8907
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Country | US
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Telephone | 501-868-9699
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | E-4394
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License Number State | AR
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