Basic Information
Provider Information
NPI: 1811351810
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YERRAPRAGADA
FirstName: ADITYA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
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Mailing Information
Address1: 4740 PEARL PKWY STE 200
Address2:  
City: BOULDER
State: CO
PostalCode: 803013080
CountryCode: US
TelephoneNumber: 3034492730
FaxNumber: 3034495821
Practice Location
Address1: 4740 PEARL PKWY STE 200
Address2:  
City: BOULDER
State: CO
PostalCode: 803013080
CountryCode: US
TelephoneNumber: 3034492730
FaxNumber: 3034495821
Other Information
ProviderEnumerationDate: 04/06/2016
LastUpdateDate: 09/12/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/12/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207XX0004XDR.0067829COY Allopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery

No ID Information.


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