Provider Demographics
NPI:1407612344
Name:ADDICTION CONSULTANTS OF PENNSYLVANIA
Entity Type:Organization
Organization Name:ADDICTION CONSULTANTS OF PENNSYLVANIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SRIKRISHNA
Authorized Official - Middle Name:V
Authorized Official - Last Name:MALAYALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-951-3599
Mailing Address - Street 1:717 S CHRISTOPHER COLUMBUS BLVD UNIT 1610
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3514
Mailing Address - Country:US
Mailing Address - Phone:304-951-3599
Mailing Address - Fax:
Practice Address - Street 1:1 UPLAND AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19015-2445
Practice Address - Country:US
Practice Address - Phone:304-951-3599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital