MEDICARE: PRIYANKA VALLABHANENI MD

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	MT200698	PA
2	207R00000X	Internal Medicine Physician	38457	OK
3	207RH0003X	Hematology & Oncology Physician	38457	OK

General Provider Information

NPI Number	:	1104190032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRIYANKA VALLABHANENI MD

Provider Business Mailing Address
First Line	:	800 NE 10TH ST # 6071
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5418
Country	:	US
Telephone Number	:	405-271-4022
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 NE 10TH ST # 6071
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5418
Country	:	US
Telephone Number	:	405-271-4022
Fax Number	:

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

Provider Enumeration Date	:	02/23/2012
Last Update Date	:	05/14/2024

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