Provider Demographics
NPI:1790730604
Name:YELAMANCHILI, PRIDHVI RAJAKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:PRIDHVI
Middle Name:RAJAKUMAR
Last Name:YELAMANCHILI
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 1:2045 S VINEYARD STE 119
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6889
Mailing Address - Country:US
Mailing Address - Phone:480-786-9685
Mailing Address - Fax:480-304-3460
Practice Address - Street 1:2045 S VINEYARD STE 119
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6889
Practice Address - Country:US
Practice Address - Phone:480-786-9685
Practice Address - Fax:480-304-3460
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2018-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46488207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I52620Medicare UPIN