Provider Demographics
NPI:1659395713
Name:WALIA, ANURAG (MD)
Entity Type:Individual
Prefix:DR
First Name:ANURAG
Middle Name:
Last Name:WALIA
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 1:2121 OREGON PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4604
Mailing Address - Country:US
Mailing Address - Phone:717-945-7308
Mailing Address - Fax:717-473-7058
Practice Address - Street 1:2121 OREGON PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4604
Practice Address - Country:US
Practice Address - Phone:717-945-7308
Practice Address - Fax:717-473-7058
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0025972084N0400X
PAMD4275362084N0400X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020455790001Medicaid
NY02805223Medicaid
PA1020455790001Medicaid
PA112697Medicare PIN
NY02805223Medicaid
NY706N01Medicare ID - Type Unspecified