Healthcare Provider Details

I. General information

NPI: 1669793014
Provider Name (Legal Business Name): NEELIMA VIDULA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT STREET YAWKEY 7
BOSTON MA
02114-2696
US

IV. Provider business mailing address

320 AVENA CIRCLE
NAPERVILLE IL
60565-1357
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA125478
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125058627
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: