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General NPI Number Information
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NPI Number | 1780105072
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Entity Type | Individual
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Provider Name | TANUJA YALAMARTI
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Gender | Female
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 801 W MAPLE ST
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City | FARMINGTON
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State | NM
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Zip | 87401-5630
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Country | US
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Telephone | 505-609-6200
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Fax | 505-609-2259
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Provider Business Mailing Address
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Address Line | 800 SPRUCE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-6130
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MT213786
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | MD2024-0294
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License Number State | NM
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