Healthcare Provider Details

I. General information

NPI: 1073544284
Provider Name (Legal Business Name): SOLOMON S KUCHIPUDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 EASTON AVE
SOMERSET NJ
08873-1975
US

IV. Provider business mailing address

636 EASTON AVE
SOMERSET NJ
08873-1975
US

V. Phone/Fax

Practice location:
  • Phone: 732-220-8811
  • Fax: 732-220-1300
Mailing address:
  • Phone: 732-220-8811
  • Fax: 732-220-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA74312
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: