Basic Information
Provider Information
NPI: 1770010555
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RACHARLA
FirstName: LEKHA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 689
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181051556
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1250 S CEDAR CREST BLVD STE 300
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181036381
CountryCode: US
TelephoneNumber: 6104023110
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/11/2017
LastUpdateDate: 06/23/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/23/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XOT017878PAY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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