Provider Demographics
NPI:1407914302
Name:PERICHERLA, VENKATA
Entity Type:Individual
Prefix:
First Name:VENKATA
Middle Name:
Last Name:PERICHERLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-0482
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1710 6TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2324
Practice Address - Country:US
Practice Address - Phone:814-946-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064819L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01715759Medicaid
PA2935311OtherAETNA HMO
PA71074OtherGEISINGER INDIVIDUAL NUMB
PA94713OtherAETNA PCP
PAP002570OtherGATEWAY GROUP NUMBER
PA110238747OtherRAILROAD MEDICARE INDIVID
PADB5128OtherRAILROAD MEDICARE GROUP
PA001356416OtherHIGHMARK GROUP NUMBER
PA132752OtherTHREE RIVERS GROUP NUMBER
PA202690OtherUPMC GROUP NUMBER
PA608776500OtherBLACK LUNG
PA7594350OtherAETNA PPO
PA977178OtherHIGHMARK INDIVIDUAL NUMBE
PAW462OtherGEISINGER GROUP NUMBER
PA0018859820006Medicaid
PA185780OtherHEALTH ASSURANCE NUMBER
PA1526043OtherGATEWAY INDIVIDUAL NUMBER