Provider Demographics
NPI:1235210352
Name:YALAMANCHI, GEETA (MD)
Entity Type:Individual
Prefix:
First Name:GEETA
Middle Name:
Last Name:YALAMANCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GEETA
Other - Middle Name:
Other - Last Name:RAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7 SANTORA DR
Mailing Address - Street 2:
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-2313
Mailing Address - Country:US
Mailing Address - Phone:732-423-8292
Mailing Address - Fax:908-450-7737
Practice Address - Street 1:245 UNION AVE STE 2A
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3064
Practice Address - Country:US
Practice Address - Phone:732-423-8292
Practice Address - Fax:908-450-7737
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08109500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00366127OtherRAIL ROAD MEDICARE
PA1017857380001Medicaid
PA2778772000OtherINDEPENCE BLUE CROSS
PA1911046OtherHIGHMARK BLUE SHEILD
PA1017857380001Medicaid
PA106861T20Medicare PIN