Healthcare Provider Details

I. General information

NPI: 1578599130
Provider Name (Legal Business Name): UGANDHAR RAO VEMULAPALLI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 MARYLAND AVE
BALTIMORE MD
21218-5614
US

IV. Provider business mailing address

2117 MARYLAND AVE
BALTIMORE MD
21218-5614
US

V. Phone/Fax

Practice location:
  • Phone: 410-244-7350
  • Fax: 410-244-7351
Mailing address:
  • Phone: 410-244-7350
  • Fax: 410-244-7351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberD0063598
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: