Individual
B R YALAMANCHILI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
320 LORETTO RD, LEBANON, KY 40033-1300
(270) 692-5158
Mailing address
PO BOX 182255, COLUMBUS, OH 43218-2255
(513) 852-2442
(614) 430-5742
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
21936
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000071071
ANTHEM
—
05
—
64781651
—
KY
Enumeration date
05/28/2006
Last updated
08/21/2007
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