Provider Demographics
NPI:1992864474
Name:MALLAVARAPU, VAMSHI K (MD)
Entity Type:Individual
Prefix:
First Name:VAMSHI
Middle Name:K
Last Name:MALLAVARAPU
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:118 WELSH RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2242
Mailing Address - Country:US
Mailing Address - Phone:215-517-1038
Mailing Address - Fax:215-517-1049
Practice Address - Street 1:118 WELSH RD UNIT B
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2242
Practice Address - Country:US
Practice Address - Phone:215-517-1038
Practice Address - Fax:215-517-1049
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2024-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD429337L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA108067Medicare PIN