Basic Information
| Provider Information | |||||||||
| NPI: | 1255449906 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAGARAJ | ||||||||
| FirstName: | HOSAHALLY | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 617 | ||||||||
| Address2: | |||||||||
| City: | SOMERTON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853500617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283157910 | ||||||||
| FaxNumber: | 9287226113 | ||||||||
| Practice Location | |||||||||
| Address1: | 151 S OAK AVE STE 6 | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853360756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286620409 | ||||||||
| FaxNumber: | 9287226113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 187428 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 01269772 | 05 | NY | MEDICAID | 10001449 | 01 | NY | CDPHP | OTHER | 000410983001 | 01 | NY | BSNENY | OTHER | 2600296 | 01 | NY | GHI | OTHER | 187428-8CAN | 01 | NY | WC | OTHER | 5765306 | 01 | NY | AETNA | OTHER | 05277 | 01 | NY | MVP | OTHER | 12G281 | 01 | NY | EMPIRE BS | OTHER |