Healthcare Provider Details

I. General information

NPI: 1316511876
Provider Name (Legal Business Name): AVINASH PUCHALAPALLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 07/06/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GREENTREE CENTRE SUITE 100
MARLTON NJ
08053-3422
US

IV. Provider business mailing address

5 GREENTREE CENTRE SUITE 100
MARLTON NJ
08053-3422
US

V. Phone/Fax

Practice location:
  • Phone: 833-494-6724
  • Fax:
Mailing address:
  • Phone: 833-494-6724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA12232700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: