Provider Demographics
NPI:1972536332
Name:NAGELLA, ASHOK K (MD)
Entity type:Individual
Prefix:
First Name:ASHOK
Middle Name:K
Last Name:NAGELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1055 RUTH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1740
Mailing Address - Country:US
Mailing Address - Phone:928-445-5211
Mailing Address - Fax:928-776-8484
Practice Address - Street 1:3112 CLEARWATER DR
Practice Address - Street 2:SUITE B
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7187
Practice Address - Country:US
Practice Address - Phone:928-541-9885
Practice Address - Fax:928-776-8484
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ375352084P0800X
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12953Medicare UPIN