Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | D0044213 | MD |
NPI | 1053356378 |
---|---|
Provider Name | Dr. Ravi Yalamanchili |
First Address | Frederick, MD 21702 |
Second Address | Frederick, MD 21702-4502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 01/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0089078000 | (05) | WV |
140003753 | MEDICARE RAILROAD (01) | |
216701800 | (05) | MD |
F57395 | (02) |