Provider Demographics
NPI:1902879364
Name:NALLATHAMBI MEDICAL ASSOC
Entity Type:Organization
Organization Name:NALLATHAMBI MEDICAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:S
Authorized Official - Middle Name:A
Authorized Official - Last Name:NALLATHAMBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-283-0212
Mailing Address - Street 1:131 E CUNNINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001
Mailing Address - Country:US
Mailing Address - Phone:724-283-0212
Mailing Address - Fax:724-283-2404
Practice Address - Street 1:131 E CUNNINGHAM ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001
Practice Address - Country:US
Practice Address - Phone:724-283-0212
Practice Address - Fax:724-283-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01935387Medicaid
PA01935387Medicaid