Provider Demographics
NPI:1053356378
Name:YALAMANCHILI, RAVI (MD)
Entity type:Individual
Prefix:DR
First Name:RAVI
Middle Name:
Last Name:YALAMANCHILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 THOMAS JOHNSON DR. SUITE 200
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
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
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044213207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD216701800Medicaid
140003753OtherMEDICARE RAILROAD
WV0089078000Medicaid
WVYA4062541Medicare PIN
MD770L771DMedicare PIN
140003753OtherMEDICARE RAILROAD
MD216701800Medicaid