Healthcare Provider Details

I. General information

NPI: 1083785158
Provider Name (Legal Business Name): UMAMAHESWARA RAO VELLANKI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2006
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3162 EL CAMINO DR
SPRINGFIELD OH
45503-1318
US

IV. Provider business mailing address

3162 EL CAMINO DR
SPRINGFIELD OH
45503-1318
US

V. Phone/Fax

Practice location:
  • Phone: 937-342-9030
  • Fax: 937-342-9039
Mailing address:
  • Phone: 937-342-9030
  • Fax: 937-342-9039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35063060
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: