Provider Demographics
NPI:1366799025
Name:YARRABOLU, THARAKANATHA REDDY (MD)
Entity type:Individual
Prefix:
First Name:THARAKANATHA
Middle Name:REDDY
Last Name:YARRABOLU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 S ALAMEDA ST
Mailing Address - Street 2:202
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1721
Mailing Address - Country:US
Mailing Address - Phone:361-694-5082
Mailing Address - Fax:361-694-4641
Practice Address - Street 1:3533 S ALAMEDA ST
Practice Address - Street 2:202
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1721
Practice Address - Country:US
Practice Address - Phone:361-694-5082
Practice Address - Fax:361-694-4641
Is Sole Proprietor?:No
Enumeration Date:2012-08-12
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXP7372208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM90882865Medicaid
OK200546340 AMedicaid
TX332738901Medicaid
TX332738902Medicaid
NM90882865Medicaid