Praveen Venkata Polamraju, is a medicare enrolled "Student In An Organized Health Care Education/training Program" physician in Boston, Massachusetts. His current practice location is
55 Fruit St, Boston, Massachusetts. You can reach out to his office (for appointments etc.) via phone at
(617) 726-2000.
Praveen Venkata Polamraju is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1417418260.
Physician's Profile
Full Name | Praveen Venkata Polamraju |
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Gender | Male |
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Speciality | Student In An Organized Health Care Education/training Program |
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Location | 55 Fruit St, Boston, Massachusetts |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1417418260
- Provider Enumeration Date: 03/26/2019
- Last Update Date: 05/03/2024
Medicare PECOS Information:
- PECOS PAC ID: 8729418249
- Enrollment ID: I20200424001856
Medical Identifiers
Medical identifiers for Praveen Venkata Polamraju such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1417418260 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
2085R0202X | Radiology - Diagnostic Radiology | 1018036 (Massachusetts) | Secondary |
390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Praveen Venkata Polamraju is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Praveen Venkata Polamraju, 713 E Anderson St, Weatherford, TX 76086-5705 Ph: (940) 395-6666 | Praveen Venkata Polamraju, 55 Fruit St, Boston, MA 02114-2621 Ph: (617) 726-2000 |
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