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Dr. Ananda Walaliyadda, MD
Specialist in Pocatello, Idaho
NPI 1497747703

Ananda Walaliyadda is a Specialist based in Pocatello, ID. Ananda Walaliyadda practices in Pocatello, ID and has the professional credentials of MD. The NPI Number for Ananda Walaliyadda is 1497747703 and holds a License No. M8731 (Idaho).

The current practice location address for Ananda Walaliyadda is 1448 E Center St, Pocatello, ID and can be reached out via phone at 208-234-1300 and via fax at 208-234-1333.

Location: 1448 E Center St, Pocatello, ID, 83201-4132
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1497747703
Provider Name
Ananda Walaliyadda
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
1448 E Center St, Pocatello, ID, 83201-4132
Phone Number
208-234-1300
Fax Number
208-234-1333
Provider Enumeration Date
08/22/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
J9521 01 ID BLUE CROSS
institution
Provider Business Practice Location Address Details
Address
1448 E Center St
City
Pocatello
State
Idaho
Zip
83201-4132
Phone Number
208-234-1300
Fax Number
208-234-1333
person
Provider Business Mailing Address Details
Address
1448 E Center St
City
Pocatello
State
Idaho
Zip
83201-4132
Phone Number
208-234-1300
Fax Number
208-234-1333
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
M8731 (Idaho)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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