Provider Demographics
NPI:1952318891
Name:ALTOONA INTERNAL MEDICINE P.C.
Entity Type:Organization
Organization Name:ALTOONA INTERNAL MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VENKATA
Authorized Official - Middle Name:RAMA RAJU
Authorized Official - Last Name:PERICHERLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-946-1818
Mailing Address - Street 1:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-0482
Mailing Address - Country:US
Mailing Address - Phone:814-946-1818
Mailing Address - Fax:814-569-3039
Practice Address - Street 1:1710 6TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2324
Practice Address - Country:US
Practice Address - Phone:814-946-1818
Practice Address - Fax:814-569-3039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064819L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADB5128OtherRAILROAD MEDICARE NUMBER
PA202690OtherUPMC GROUP NUMBER
PA0018859820006Medicaid
PA185780OtherHEALTH ASSURANCE NUMBER
PAW462OtherGEISINGER NUMBER
PA202690OtherUPMC GROUP NUMBER
PAW462OtherGEISINGER NUMBER