Provider Demographics
NPI:1336458322
Name:MALAYALA, SRIKRISHNA VARUN (MD)
Entity Type:Individual
Prefix:DR
First Name:SRIKRISHNA
Middle Name:VARUN
Last Name:MALAYALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-926-9010
Mailing Address - Fax:215-226-8285
Practice Address - Street 1:7600 CENTRAL AVE
Practice Address - Street 2:2ND FL FOUNDER'S BLDG
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2442
Practice Address - Country:US
Practice Address - Phone:215-728-2000
Practice Address - Fax:215-214-4119
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD453391207R00000X
NYSSN/ITIN DELETED207R00000X
DE344878207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACD4829OtherTPI RR MEDICARE
PA100727800OtherTPI MEDICAID GROUP
PA597586OtherTPI MEDICARE