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1649273715

NPI Code Detail

MEDICARE: CHRISTOPHER T MALLAVARAPU MD

MEDICARE: CHRISTOPHER T MALLAVARAPU 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	207UN0901X	Nuclear Cardiology Physician	183914	NY
2	207RC0000X	Cardiovascular Disease Physician	183914	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	130730000068	OTHER	NY	FIDELIS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3997380	OTHER	NY	EMBLEM HEALTH

General Provider Information

NPI Number	:	1649273715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER T MALLAVARAPU MD

Provider Business Mailing Address
First Line	:	86 NAVESINK AVE
Second Line	:
City	:	RUMSON
State	:	NJ
Zip	:	07760-2043
Country	:	US
Telephone Number	:	337-296-8523
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 MAIN ST
Second Line	:
City	:	OLEAN
State	:	NY
Zip	:	14760-1513
Country	:	US
Telephone Number	:	716-373-2600
Fax Number	:

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/24/2024

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Directions to “ CHRISTOPHER T MALLAVARAPU MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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