Healthcare Provider Details

I. General information

NPI: 1699075127
Provider Name (Legal Business Name): PADMASREE GUMIDYALA MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

974 INMAN AVENUE SUITE 1-A, ABC PEDIATRICS
EDISON NJ
08820
US

IV. Provider business mailing address

974 INMAN AVENUE SUITE 1-A, ABC PEDIATRICS
EDISON NJ
08820
US

V. Phone/Fax

Practice location:
  • Phone: 908-412-8866
  • Fax: 908-412-9363
Mailing address:
  • Phone: 908-412-8866
  • Fax: 908-412-9363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08850000
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: