Provider Demographics
NPI:1700868650
Name:BARRELLA, AMANDA LYDIA (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYDIA
Last Name:BARRELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11306 ANAQUA SPGS
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-8494
Mailing Address - Country:US
Mailing Address - Phone:210-385-2607
Mailing Address - Fax:
Practice Address - Street 1:11306 ANAQUA SPGS STE 900
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-8494
Practice Address - Country:US
Practice Address - Phone:210-385-2607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7994207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G4405OtherBLUE CROSS BLUE SHIELD
TX0467185-02Medicaid
TXG92539Medicare UPIN