1942489158 NPI number — BOSE YALAMANCHI MD PA

Table of content: (NPI 1942489158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942489158 NPI number — BOSE YALAMANCHI MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOSE YALAMANCHI MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

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 Information

NPI Number:
1942489158
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11334 WILES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33076-2114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-344-4555
Provider Business Mailing Address Fax Number:
954-344-4554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11334 WILES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33076-2114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-344-4555
Provider Business Practice Location Address Fax Number:
954-344-4554
Provider Enumeration Date:
10/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YALAMANCHI
Authorized Official First Name:
BOSE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER / MD
Authorized Official Telephone Number:
954-344-4555

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 049469100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 013877900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com