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
Phone: (208) 234-1300
Fax: (208) 234-1333
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1497747703 | NPPES |
| Idaho | Other | J9521 | BLUE CROSS |
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