Provider Demographics
NPI:1407074057
Name:UMAMAHESWARA RAO VEJENDLA PHYSICIAN PC
Entity Type:Organization
Organization Name:UMAMAHESWARA RAO VEJENDLA PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:UMAMAHESWARA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEJENDLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-664-5290
Mailing Address - Street 1:152 FOOTE AVENUE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701
Mailing Address - Country:US
Mailing Address - Phone:716-664-5290
Mailing Address - Fax:
Practice Address - Street 1:152 FOOTE AVENUE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701
Practice Address - Country:US
Practice Address - Phone:716-664-5290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1407074057Medicare NSC