Basic Information
| Provider Information | |||||||||
| NPI: | 1952633810 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHEPPALLI | ||||||||
| FirstName: | NAGA SURESH | ||||||||
| MiddleName: | PR | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | HARTSVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295504765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433833742 | ||||||||
| FaxNumber: | 8433833745 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | HARTSVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295504765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433833742 | ||||||||
| FaxNumber: | 8433833745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2010 | ||||||||
| LastUpdateDate: | 12/12/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD60372855 | WA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 40073 | SC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.