1235210352 NPI number — GEETA YALAMANCHI MD

Table of content: GEETA YALAMANCHI MD (NPI 1235210352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235210352 NPI number — GEETA YALAMANCHI MD

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAO
Provider Other First Name:
GEETA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235210352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 SANTORA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RARITAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08869-2313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-423-8292
Provider Business Mailing Address Fax Number:
908-450-7737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 UNION AVE STE 2A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEWATER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08807-3064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-423-8292
Provider Business Practice Location Address Fax Number:
908-450-7737
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  25MA08109500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00366127 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1017857380001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2778772000 . This is a "INDEPENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1911046 . This is a "HIGHMARK BLUE SHEILD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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