Walaliyadda, Ananda

Walaliyadda, Ananda is an individual health care provider with primary practice located at 1448 E Center St Suite E, Pocatello ID 83201-4132. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Walaliyadda, Ananda can be contacted via phone (208) 234-1300.

Contact Information

Primary practice address
1448 E Center St Suite E Pocatello ID 83201-4132
Fax: (208) 234-1333
Website:

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X M8731 Idaho

Profile Details

NPI number 1497747703
LBN Legal business name Walaliyadda, Ananda
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 22nd, 2005
Last updated Jun 29th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497747703 NPPES
Idaho Other J9521 BLUE CROSS

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