Provider Demographics
NPI:1487803615
Name:ALURI, VIDYA MURTY (MD)
Entity type:Individual
Prefix:DR
First Name:VIDYA
Middle Name:MURTY
Last Name:ALURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 HIGHLAND PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241
Mailing Address - Country:US
Mailing Address - Phone:585-967-1220
Mailing Address - Fax:318-434-1413
Practice Address - Street 1:2461 10TH STREET STE 101
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241
Practice Address - Country:US
Practice Address - Phone:319-474-5749
Practice Address - Fax:319-343-1413
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD41731207R00000X
IAMD-41731207RE0101X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03393428Medicaid
NYJ400051603Medicare PIN
NY10712AMedicare PIN
NYJ400051602Medicare PIN
NY70005AMedicare PIN