Healthcare Provider Details

I. General information

NPI: 1205498235
Provider Name (Legal Business Name): HASITHA VEMULA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2019
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 BAY RD., UNIT B
DOVER DE
19901
US

IV. Provider business mailing address

640 S. STATE ST. MAIL CODE 3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 24-011-5003
  • Fax: 302-672-6450
Mailing address:
  • Phone: 302-401-1500
  • Fax: 26-726-4503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberC1-0026688
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: