Provider Demographics
NPI:1083785158
Name:VELLANKI, UMAMAHESWARA RAO (MD)
Entity Type:Individual
Prefix:DR
First Name:UMAMAHESWARA
Middle Name:RAO
Last Name:VELLANKI
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 1:3162 EL CAMINO DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-1318
Mailing Address - Country:US
Mailing Address - Phone:937-342-9030
Mailing Address - Fax:937-342-9039
Practice Address - Street 1:3162 EL CAMINO DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-1318
Practice Address - Country:US
Practice Address - Phone:937-342-9030
Practice Address - Fax:937-342-9039
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350630602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0718628OtherMEDICARE IDENTIFICATION
OH0879492Medicaid
OH0718628Medicare PIN
OH0879492Medicaid