Provider Demographics
NPI:1285615229
Name:VAMADEVAMURTHY, MOLAKALMURU (MD)
Entity type:Individual
Prefix:
First Name:MOLAKALMURU
Middle Name:
Last Name:VAMADEVAMURTHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MHV
Other - Middle Name:
Other - Last Name:MURTHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1719 UNION AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2146
Mailing Address - Country:US
Mailing Address - Phone:724-226-2128
Mailing Address - Fax:724-226-2498
Practice Address - Street 1:1719 UNION AVE
Practice Address - Street 2:SUITE A
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2146
Practice Address - Country:US
Practice Address - Phone:724-226-2128
Practice Address - Fax:724-226-2498
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038181L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007244120001Medicaid
PAB40147Medicare UPIN
PA156037Medicare PIN