Provider Demographics
NPI:1992146476
Name:YERASI, CHARAN TEJA REDDY (MD)
Entity type:Individual
Prefix:
First Name:CHARAN
Middle Name:TEJA REDDY
Last Name:YERASI
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 1:10503 W THUNDERBIRD BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3047
Mailing Address - Country:US
Mailing Address - Phone:623-974-3649
Mailing Address - Fax:623-974-3649
Practice Address - Street 1:10503 W THUNDERBIRD BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3047
Practice Address - Country:US
Practice Address - Phone:623-974-3649
Practice Address - Fax:623-974-3649
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ62611207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ62611OtherARIZONA MEDICAL BOARD