Healthcare Provider Details

I. General information

NPI: 1871025007
Provider Name (Legal Business Name): ANJAN VENKATA MARELLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE
TROY NY
12180-3410
US

IV. Provider business mailing address

1600 7TH AVE
TROY NY
12180-3410
US

V. Phone/Fax

Practice location:
  • Phone: 518-290-0229
  • Fax: 502-237-6656
Mailing address:
  • Phone: 518-290-0229
  • Fax: 502-237-6656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number305796
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number63903
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number283264
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number65352
License Number StateCT
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number305796
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: