Provider Demographics
NPI:1548407810
Name:MARELLA, PRASANTHI (M D)
Entity Type:Individual
Prefix:
First Name:PRASANTHI
Middle Name:
Last Name:MARELLA
Suffix:
Gender:F
Credentials:M D
Other - Prefix:DR
Other - First Name:PRASANTHI
Other - Middle Name:
Other - Last Name:NALLURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M D
Mailing Address - Street 1:PO BOX 78331
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:801 N BAY ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-2941
Practice Address - Country:US
Practice Address - Phone:352-589-6367
Practice Address - Fax:352-357-0411
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME157521207R00000X
PAMD435259207R00000X
NY250537-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3733889000OtherINDEPENDENCE BLUE CROSS
PA50087605OtherCAPITAL BLUE CROSS
PA1023665930001Medicaid
PA1023665930001Medicaid