Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0203X | Pediatric Critical Care Doctor | 01049779A | IN |
Y | 2080P0214X | Pediatric Pulmonologist | 01049779A | IN |
NPI | 1336161868 |
---|---|
Provider Name | Dr. Chandrashekhar Yalamanchali |
First Address | Fort Wayne, IN 46845-1701 |
Second Address | Fort Wayne, IN 46845-1707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 14/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200231310 | (05) | IN |
200231310A | (05) | IN |
G97909 | (02) | IN |