Active NPI
Chetan Yelamanchi, DDS
- Endodontics
- Rockville, MD
National Provider Identifier
1154573913
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 15959
- Practice address
- 11125 Rockville Pike Ste 103
Rockville, MD 20852-3142 - Phone
- (650) 245-3047
- NPI assigned
- Oct 10, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 15959 | MD | Primary |
Addresses
Primary practice location
11125 Rockville Pike Ste 103
Rockville, MD 20852-3142
Mailing address
10412 Grey Fox Rd
Potomac, MD 20854-1904
Phone (650) 245-3047
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160329000538 | MD | Order and Referring Only - Other (Physician) | 8628375110 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655251200000",
"number": "1154573913",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10412 GREY FOX RD",
"city": "POTOMAC",
"state": "MD",
"postal_code": "208541904",
"telephone_number": "650-245-3047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11125 ROCKVILLE PIKE STE 103",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208523142",
"telephone_number": "650-245-3047"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YELAMANCHI",
"first_name": "CHETAN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-10-10",
"last_updated": "2022-06-15",
"certification_date": "2022-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "MD",
"license": "15959",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.