Provider Demographics
NPI:1477528784
Name:YENUMULA, PANDURANGA REDDY (MD)
Entity Type:Individual
Prefix:
First Name:PANDURANGA
Middle Name:REDDY
Last Name:YENUMULA
Suffix:
Gender:M
Credentials:MD
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 1066
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-7066
Mailing Address - Country:US
Mailing Address - Phone:508-595-0531
Mailing Address - Fax:508-829-4951
Practice Address - Street 1:2 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 406
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1270
Practice Address - Country:US
Practice Address - Phone:413-732-4269
Practice Address - Fax:413-788-0944
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224458208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2105951Medicaid
MA2105951Medicaid
MAA38821Medicare ID - Type Unspecified