Provider Demographics
NPI:1417012758
Name:RAVI YALAMANCHILI, M.D, P.A
Entity type:Organization
Organization Name:RAVI YALAMANCHILI, M.D, P.A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:YALAMANCHILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-846-0100
Mailing Address - Street 1:141 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4502
Mailing Address - Country:US
Mailing Address - Phone:301-846-0100
Mailing Address - Fax:301-846-0244
Practice Address - Street 1:141 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE # 200
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4502
Practice Address - Country:US
Practice Address - Phone:301-846-0100
Practice Address - Fax:301-846-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CG7938OtherMEDICARE RAILROAD
WV3810005071Medicaid
MD063205800Medicaid
DCG01215Medicare PIN
WV9318631Medicare PIN
MD063205800Medicaid
MD770LMedicare PIN