Provider Demographics
NPI:1023258126
Name:KAKIMALLAIAH, NALINI G (MD)
Entity type:Individual
Prefix:
First Name:NALINI
Middle Name:G
Last Name:KAKIMALLAIAH
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 1:1401 ELECTRIC ST
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18509-2098
Mailing Address - Country:US
Mailing Address - Phone:570-770-5929
Mailing Address - Fax:570-207-7886
Practice Address - Street 1:700 QUINCY AVE
Practice Address - Street 2:HOSPITALIST OFFICE
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1724
Practice Address - Country:US
Practice Address - Phone:866-519-0457
Practice Address - Fax:570-770-5263
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD440504207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025143460005Medicaid
PA188665YGDBMedicare PIN