Provider Demographics
NPI:1578645123
Name:VELLORE MEDICAL ASSOCIATES,P.C.
Entity Type:Organization
Organization Name:VELLORE MEDICAL ASSOCIATES,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THRIVENI
Authorized Official - Middle Name:RAMKUMAR
Authorized Official - Last Name:VELLORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-882-4000
Mailing Address - Street 1:3893 ADLER PL
Mailing Address - Street 2:SUITE 160, BLDG B
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-9072
Mailing Address - Country:US
Mailing Address - Phone:610-882-4000
Mailing Address - Fax:610-882-4022
Practice Address - Street 1:3893 ADLER PL
Practice Address - Street 2:SUITE 160, BLDG B
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-9072
Practice Address - Country:US
Practice Address - Phone:610-882-4000
Practice Address - Fax:610-882-4022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH95105Medicare UPIN