Provider Demographics
NPI:1407886336
Name:VELLANKI, NANDAKUMAR B (MD)
Entity Type:Individual
Prefix:DR
First Name:NANDAKUMAR
Middle Name:B
Last Name:VELLANKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7350 VAN DUSEN RD
Mailing Address - Street 2:STE 130
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5267
Mailing Address - Country:US
Mailing Address - Phone:301-560-4747
Mailing Address - Fax:301-776-1725
Practice Address - Street 1:8850 COLUMBIA 100 PKWY
Practice Address - Street 2:STE 301
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2377
Practice Address - Country:US
Practice Address - Phone:301-560-4747
Practice Address - Fax:301-776-1725
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD30469207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD398281500Medicaid
MD398281500Medicaid
MD8995Medicare ID - Type Unspecified