Provider Demographics
NPI:1528021060
Name:YALAMANCHILI, RAJASEKHARA R (MD FAAFP)
Entity Type:Individual
Prefix:MR
First Name:RAJASEKHARA
Middle Name:R
Last Name:YALAMANCHILI
Suffix:
Gender:M
Credentials:MD FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11111 JONES RD
Mailing Address - Street 2:SUITE #6
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070
Mailing Address - Country:US
Mailing Address - Phone:281-955-7055
Mailing Address - Fax:281-890-2341
Practice Address - Street 1:11111 JONES RD
Practice Address - Street 2:SUITE #6
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070
Practice Address - Country:US
Practice Address - Phone:281-955-7055
Practice Address - Fax:281-890-2341
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7744207Q00000X
ARR2577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GF22OtherBCBS
1015944OtherAETNA
C23826Medicare UPIN
00GF22Medicare ID - Type Unspecified