Provider Demographics
NPI:1790718153
Name:LINGANNA, BHATTARAHALLY YELLAPPA (MD)
Entity Type:Individual
Prefix:DR
First Name:BHATTARAHALLY
Middle Name:YELLAPPA
Last Name:LINGANNA
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 1:1232 S MILL ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-4812
Mailing Address - Country:US
Mailing Address - Phone:724-654-2719
Mailing Address - Fax:724-654-2404
Practice Address - Street 1:1232 S MILL ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-4812
Practice Address - Country:US
Practice Address - Phone:724-654-2719
Practice Address - Fax:724-654-2404
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 020402-E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0724566Medicaid
PAA87880Medicare UPIN
PA0724566Medicaid