Provider Demographics
NPI:1194700476
Name:YALAMANCHI, BOSE (MD PA)
Entity type:Individual
Prefix:DR
First Name:BOSE
Middle Name:
Last Name:YALAMANCHI
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 WILES RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2114
Mailing Address - Country:US
Mailing Address - Phone:954-344-4555
Mailing Address - Fax:954-840-8254
Practice Address - Street 1:1134 WILES RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-2114
Practice Address - Country:US
Practice Address - Phone:954-344-4555
Practice Address - Fax:954-840-8254
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040693208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL592420003OtherTAX ID
FL049469100Medicaid
FL94085Medicare ID - Type Unspecified
FL592420003OtherTAX ID