Basic Information
| Provider Information | |||||||||
| NPI: | 1285615229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAMADEVAMURTHY | ||||||||
| FirstName: | MOLAKALMURU | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MURTHY | ||||||||
| OtherFirstName: | MHV | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1719 UNION AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | NATRONA HEIGHTS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150652146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242262128 | ||||||||
| FaxNumber: | 7242262498 | ||||||||
| Practice Location | |||||||||
| Address1: | 1719 UNION AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | NATRONA HEIGHTS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150652146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242262128 | ||||||||
| FaxNumber: | 7242262498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 12/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD038181L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0007244120001 | 05 | PA | MEDICAID |