MEDICARE: PRASANTHI MARELLA 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	207R00000X	Internal Medicine Physician	ME157521	FL
2	207R00000X	Internal Medicine Physician	MD435259	PA
3	207R00000X	Internal Medicine Physician	250537-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3733889000	OTHER	PA	INDEPENDENCE BLUE CROSS
2	50087605	OTHER	PA	CAPITAL BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548407810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRASANTHI MARELLA M D

Provider Business Mailing Address
First Line	:	PO BOX 78331
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-3311
Country	:	US
Telephone Number	:	484-884-4500
Fax Number	:	484-884-0699

Provider Business Practice Location Address
First Line	:	801 N BAY ST
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32726-2941
Country	:	US
Telephone Number	:	352-589-6367
Fax Number	:	352-357-0411

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

Provider Enumeration Date	:	01/08/2009
Last Update Date	:	01/31/2023

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Directions to “ PRASANTHI MARELLA M D” Practice Location

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