Basic Information
| Provider Information | |||||||||
| NPI: | 1821295163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANANTHARAJ | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1803 MOUNT ROSE AVE | ||||||||
| Address2: | STE B3 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178516969 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 S GEORGE ST | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178514005 | ||||||||
| FaxNumber: | 7178122495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 12/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD431293 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 217568 | 01 | PA | UNISON-WMG | OTHER | 2161248 | 01 | MAMSI WMG | OTHER | 50070969 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 9322074 | 01 | PA | AETNA | OTHER | 109843 | 01 | PA | GEISINGER | OTHER | 1563944 | 01 | PA | GATEWAY-WMG | OTHER | 1973444 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 211398 | 01 | PA | JOHNS HOPKINS | OTHER | 2852804000 | 01 | PA | AMERIHEALTH 65PA | OTHER | 101959345 | 05 | PA | MEDICAID | 20064469 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 897873 | 01 | MD | CAREFIRST MD BCBS | OTHER |