1821295163 NPI number — ANGELA P ANANTHARAJ MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821295163 NPI number — ANGELA P ANANTHARAJ MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ANANTHARAJ

Provider First Name:

ANGELA

Provider Middle Name:

P

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1821295163

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/14/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1803 MOUNT ROSE AVE

Provider Second Line Business Mailing Address:

STE B3

Provider Business Mailing Address City Name:

YORK

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

17403-3026

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

717-851-1405

Provider Business Mailing Address Fax Number:

717-851-6969

Provider First Line Business Practice Location Address:

1001 S GEORGE ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

YORK

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

17403-3676

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

717-851-4005

Provider Business Practice Location Address Fax Number:

717-812-2495

Provider Enumeration Date:

06/29/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  MD431293 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 217568 . This is a "UNISON-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2161248 . This is a "MAMSI WMG" identifier . This identifiers is of the category "OTHER".
• Identifier: 50070969 . This is a "CAPITAL BLUE CROSS-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 9322074 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 109843 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1563944 . This is a "GATEWAY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1973444 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 211398 . This is a "JOHNS HOPKINS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2852804000 . This is a "AMERIHEALTH 65PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 101959345 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 20064469 . This is a "AMERIHEALTH MERCY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 897873 . This is a "CAREFIRST MD BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".