MEDICARE: DR. UMAMAHESWARA RAO VELLANKI M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	35063060	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0718628	OTHER	OH	MEDICARE IDENTIFICATION

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083785158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. UMAMAHESWARA RAO VELLANKI M.D

Provider Business Mailing Address
First Line	:	3162 EL CAMINO DR
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-1318
Country	:	US
Telephone Number	:	937-342-9030
Fax Number	:	937-342-9039

Provider Business Practice Location Address
First Line	:	3162 EL CAMINO DR
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-1318
Country	:	US
Telephone Number	:	937-342-9030
Fax Number	:	937-342-9039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2006
Last Update Date	:	03/02/2012

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Directions to “ DR. UMAMAHESWARA RAO VELLANKI M.D” Practice Location

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