Healthcare Provider Details

I. General information

NPI: 1902194376
Provider Name (Legal Business Name): AMUDHA BOOPATHI M.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMUDHA PALANIAPPAN M.D.,

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30265 COMMERCE DR
MILLSBORO DE
19966-3593
US

IV. Provider business mailing address

PO BOX 191
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 302-629-5050
  • Fax: 302-629-5053
Mailing address:
  • Phone:
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC10011009
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0011009
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: