Provider Demographics
NPI:1780676759
Name:YERRAMALLI, SITAMAHALAKSHMI (MD)
Entity Type:Individual
Prefix:MRS
First Name:SITAMAHALAKSHMI
Middle Name:
Last Name:YERRAMALLI
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 1:1 CLARA MAASS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3550
Mailing Address - Country:US
Mailing Address - Phone:973-751-8880
Mailing Address - Fax:973-751-8950
Practice Address - Street 1:1 CLARA MAASS DR STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3550
Practice Address - Country:US
Practice Address - Phone:973-751-8880
Practice Address - Fax:973-751-8950
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03850700207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0154709Medicaid
NJC53518Medicare UPIN
NJ0154709Medicaid