Provider Demographics
NPI:1336161868
Name:YALAMANCHALI, CHANDRASHEKHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRASHEKHAR
Middle Name:
Last Name:YALAMANCHALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:YALAMANCHALI
Other - Middle Name:CS
Other - Last Name:CHOWDARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11123 PARKVIEW PLAZA DR STE 202
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1707
Practice Address - Country:US
Practice Address - Phone:260-425-6100
Practice Address - Fax:260-425-6105
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049779A2080P0203X, 2080P0214X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200231310Medicaid
IN200231310AMedicaid
ING97909Medicare UPIN
IN135650Medicare ID - Type Unspecified