Provider Demographics
NPI:1194038661
Name:MALLELA, RAJITHA (MBBS)
Entity type:Individual
Prefix:DR
First Name:RAJITHA
Middle Name:
Last Name:MALLELA
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:49 BRANTLEY CT
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1547
Mailing Address - Country:US
Mailing Address - Phone:716-510-0615
Mailing Address - Fax:
Practice Address - Street 1:295 ESSJAY ROAD
Practice Address - Street 2:BUFFALO MEDICAL GROUP
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8216
Practice Address - Country:US
Practice Address - Phone:716-857-8749
Practice Address - Fax:716-250-5965
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254835207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03258188Medicaid